Provider Demographics
NPI:1750372504
Name:WESTERN CARDIOLOGY ASSOCIATES
Entity type:Organization
Organization Name:WESTERN CARDIOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:HAFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-252-0104
Mailing Address - Street 1:PO BOX 848601
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02284-8601
Mailing Address - Country:US
Mailing Address - Phone:303-252-0104
Mailing Address - Fax:303-252-0127
Practice Address - Street 1:9141 GRANT ST
Practice Address - Street 2:SUITE 140
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4374
Practice Address - Country:US
Practice Address - Phone:303-252-0104
Practice Address - Fax:303-252-0127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-01
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04014429Medicaid
CO04014429Medicaid