Provider Demographics
NPI:1861686933
Name:ST JOSEPH HOSPITAL
Entity Type:Organization
Organization Name:ST JOSEPH HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FELLOWSHIP DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ROCCO
Authorized Official - Last Name:AMBRUSO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-363-2241
Mailing Address - Street 1:717 YOSEMITE ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-6918
Mailing Address - Country:US
Mailing Address - Phone:303-363-2241
Mailing Address - Fax:303-340-2616
Practice Address - Street 1:717 YOSEMITE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-6918
Practice Address - Country:US
Practice Address - Phone:303-363-2241
Practice Address - Fax:303-340-2616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42134282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO42134OtherSTATE MEDICAL LICENSE