Provider Demographics
NPI:1457536187
Name:WILLIAM J THIEMAN MD PC
Entity Type:Organization
Organization Name:WILLIAM J THIEMAN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER CORPORATE SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:MORGAN
Authorized Official - Last Name:THIEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-484-7245
Mailing Address - Street 1:1217 EAST ELIZABETH
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4040
Mailing Address - Country:US
Mailing Address - Phone:970-484-7245
Mailing Address - Fax:970-484-1398
Practice Address - Street 1:1217 EAST ELIZABETH
Practice Address - Street 2:SUITE 1
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4040
Practice Address - Country:US
Practice Address - Phone:970-484-7245
Practice Address - Fax:970-484-1398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19190207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01191907Medicaid
C89531Medicare PIN
CO01191907Medicaid