Provider Demographics
NPI:1689736035
Name:ARAPAHOE GASTROENTEROLOGY PC
Entity Type:Organization
Organization Name:ARAPAHOE GASTROENTEROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOUDZWAARD
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:303-722-8987
Mailing Address - Street 1:1001 SOUTHPARK DR
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-5641
Mailing Address - Country:US
Mailing Address - Phone:303-531-5724
Mailing Address - Fax:303-531-5728
Practice Address - Street 1:1001 SOUTHPARK DR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-5641
Practice Address - Country:US
Practice Address - Phone:303-531-5724
Practice Address - Fax:303-531-5728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04004248Medicaid
CO04004248Medicaid