Provider Demographics
NPI:1912372137
Name:NEW BELGIUM BREWING COMPANY, INC.
Entity Type:Organization
Organization Name:NEW BELGIUM BREWING COMPANY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BENEFITS ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:EVELYN
Authorized Official - Middle Name:JUNE
Authorized Official - Last Name:TYRRELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-494-7801
Mailing Address - Street 1:500 LINDEN ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-2457
Mailing Address - Country:US
Mailing Address - Phone:970-221-0524
Mailing Address - Fax:
Practice Address - Street 1:702A W DRAKE RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-5521
Practice Address - Country:US
Practice Address - Phone:970-229-4653
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35548261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care