Provider Demographics
NPI:1255491486
Name:UNIVERSITY OF COLORADO HOSPITAL AUTHORITY
Entity type:Organization
Organization Name:UNIVERSITY OF COLORADO HOSPITAL AUTHORITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:NICKELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-848-0000
Mailing Address - Street 1:7901 E LOWRY BLVD
Mailing Address - Street 2:F402, 3RD FLOOR
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:720-553-1754
Practice Address - Street 1:8111 E LOWRY BLVD
Practice Address - Street 2:STE 110, MS B01
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230-7255
Practice Address - Country:US
Practice Address - Phone:720-848-9590
Practice Address - Fax:720-848-9593
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNIVERSITY OF COLORADO HOSPITAL AUTHORITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-11
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
3336C0003X, 332B00000X
CO990000063333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO55388876Medicaid
0615495OtherOTHER ID NUMBER-COMMERCIAL NUMBER
CO55388876Medicaid
CO55388876Medicaid