Provider Demographics
NPI:1750573010
Name:PLATTE VALLEY INTERNAL MEDICINE & PULMONARY LLC
Entity type:Organization
Organization Name:PLATTE VALLEY INTERNAL MEDICINE & PULMONARY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:GIA
Authorized Official - Middle Name:
Authorized Official - Last Name:STEELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-659-5800
Mailing Address - Street 1:1606 PRAIRIE CENTER PKWY
Mailing Address - Street 2:SUITE #310
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-4004
Mailing Address - Country:US
Mailing Address - Phone:303-659-5800
Mailing Address - Fax:303-659-5156
Practice Address - Street 1:1606 PRAIRIE CENTER PKWY STE 310
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-4004
Practice Address - Country:US
Practice Address - Phone:303-659-5800
Practice Address - Fax:303-659-5156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-10
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38915174400000X
CO28945174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01289453Medicaid
CO110146556OtherRR MEDICARE
CO1332154Medicaid
CO89055055Medicaid
COF86202Medicare UPIN
CO1332154Medicaid
COC393828Medicare UPIN
COC515368Medicare UPIN
CO01289453Medicaid
COC393828Medicare PIN
COC515368Medicare PIN