Provider Demographics
NPI:1689841868
Name:LONGMONT HOSPITALIST GROUP, LLC
Entity Type:Organization
Organization Name:LONGMONT HOSPITALIST GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LUCAS
Authorized Official - Last Name:HUTCHISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:3034-801-0129
Mailing Address - Street 1:2030 MOUNTAIN VIEW AVE
Mailing Address - Street 2:SUITE 540
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-3178
Mailing Address - Country:US
Mailing Address - Phone:303-951-4059
Mailing Address - Fax:303-951-4060
Practice Address - Street 1:2030 MOUNTAIN VIEW AVE
Practice Address - Street 2:SUITE 540
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3178
Practice Address - Country:US
Practice Address - Phone:303-951-4059
Practice Address - Fax:303-951-4060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOB4108Medicare UPIN