Provider Demographics
NPI:1669656591
Name:HARVARD PARK MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:HARVARD PARK MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:T
Authorized Official - Last Name:COULTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-744-2706
Mailing Address - Street 1:PO BOX 5463
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-5463
Mailing Address - Country:US
Mailing Address - Phone:303-744-2706
Mailing Address - Fax:
Practice Address - Street 1:950 E HARVARD AVE
Practice Address - Street 2:SUITE 660
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-7009
Practice Address - Country:US
Practice Address - Phone:303-744-2706
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO85288721Medicaid
COC344308Medicare PIN