Provider Demographics
NPI:1891908042
Name:RUSSELL WM SIMPSON MD PC AND ASSOCIATES
Entity Type:Organization
Organization Name:RUSSELL WM SIMPSON MD PC AND ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SIMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-371-7263
Mailing Address - Street 1:4896 CHAMBERS RD
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80239
Mailing Address - Country:US
Mailing Address - Phone:303-371-7263
Mailing Address - Fax:303-371-3562
Practice Address - Street 1:4896 CHAMBERS RD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80239
Practice Address - Country:US
Practice Address - Phone:303-371-7263
Practice Address - Fax:303-371-3562
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21847207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04019089Medicaid
D28283Medicare UPIN
CO04019089Medicaid