Provider Demographics
NPI:1215129317
Name:BISHOP/PETERSEN MD PC
Entity type:Organization
Organization Name:BISHOP/PETERSEN MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BISHOP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-759-3173
Mailing Address - Street 1:720 S COLORADO BLVD
Mailing Address - Street 2:STE 455 S
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1904
Mailing Address - Country:US
Mailing Address - Phone:303-759-3173
Mailing Address - Fax:303-388-7356
Practice Address - Street 1:720 S COLORADO BLVD
Practice Address - Street 2:STE 455 S
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1904
Practice Address - Country:US
Practice Address - Phone:303-759-3173
Practice Address - Fax:303-388-7356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO223712084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1740351894OtherNPI
CO01223718Medicaid
CO134623860OtherNPI
CO1740351894OtherNPI
CO01223718Medicaid