Provider Demographics
NPI:1750449450
Name:RAGSDALE HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:RAGSDALE HEALTH SERVICES LLC
Other - Org Name:RAGSDALE PROFESSIONAL HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAGSDALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:720-855-7174
Mailing Address - Street 1:PO BOX 21150
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-4150
Mailing Address - Country:US
Mailing Address - Phone:303-546-9158
Mailing Address - Fax:303-546-9107
Practice Address - Street 1:2419 S CHASE LANE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227
Practice Address - Country:US
Practice Address - Phone:720-855-7174
Practice Address - Fax:303-394-0130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36033207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO15709736Medicaid
E54770Medicare UPIN
CO15709736Medicaid