Provider Demographics
NPI:1215910146
Name:LONGS PEAK EMERGENCY PHYSICIANS, PC
Entity type:Organization
Organization Name:LONGS PEAK EMERGENCY PHYSICIANS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:G
Authorized Official - Last Name:OGDEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-651-5000
Mailing Address - Street 1:P.O. BOX 1175
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80150-2568
Mailing Address - Country:US
Mailing Address - Phone:303-306-7783
Mailing Address - Fax:303-306-7753
Practice Address - Street 1:1950 WEST MOUNTAIN VIEW AVE.
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3129
Practice Address - Country:US
Practice Address - Phone:303-651-5000
Practice Address - Fax:303-306-7753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-23
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO48184268Medicaid
CO48184268Medicaid