Provider Demographics
NPI:1831315662
Name:NORTHERN COLORADO HOSPITALISTS PROFESSIONAL LLC
Entity Type:Organization
Organization Name:NORTHERN COLORADO HOSPITALISTS PROFESSIONAL LLC
Other - Org Name:NORTHERN COLORADO HOSPITALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HATHCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-488-1666
Mailing Address - Street 1:2637 MIDPOINT DR STE F
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-4432
Mailing Address - Country:US
Mailing Address - Phone:970-488-1666
Mailing Address - Fax:970-472-9381
Practice Address - Street 1:2637 MIDPOINT DR STE F
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-4432
Practice Address - Country:US
Practice Address - Phone:970-488-1666
Practice Address - Fax:970-472-9381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO72856548Medicaid
NE10025520600Medicaid
CODG2538OtherRAILROAD MEDICARE
CODG2538OtherRAILROAD MEDICARE