Provider Demographics
NPI:1982627493
Name:DENVER HEALTH AND HOSPITAL AUTHORITY
Entity Type:Organization
Organization Name:DENVER HEALTH AND HOSPITAL AUTHORITY
Other - Org Name:DENVER HEALTH MEDICAL CENTER I D PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANSAR
Authorized Official - Middle Name:
Authorized Official - Last Name:HASSAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-602-7083
Mailing Address - Street 1:605 BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4505
Mailing Address - Country:US
Mailing Address - Phone:303-602-8726
Mailing Address - Fax:303-602-3588
Practice Address - Street 1:605 BANNOCK ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4505
Practice Address - Country:US
Practice Address - Phone:303-602-8726
Practice Address - Fax:303-602-3588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9900003003336C0002X
3336S0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03002334Medicaid
2002703OtherPK