Provider Demographics
NPI:1750475364
Name:NORTHERN COLORADO ALLERGY & ASTHMA
Entity Type:Organization
Organization Name:NORTHERN COLORADO ALLERGY & ASTHMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISHNA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MURTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-221-2370
Mailing Address - Street 1:2121 E HARMONY RD
Mailing Address - Street 2:UNIT 350
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528
Mailing Address - Country:US
Mailing Address - Phone:970-221-2370
Mailing Address - Fax:970-221-9654
Practice Address - Street 1:2121 E HARMONY RD
Practice Address - Street 2:UNIT 350
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528
Practice Address - Country:US
Practice Address - Phone:970-221-2370
Practice Address - Fax:970-221-9654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO15178871Medicaid
CO15178871Medicaid