Provider Demographics
NPI:1306168166
Name:DENVER GERIATRICS AND INTERNAL MEDICINE
Entity type:Organization
Organization Name:DENVER GERIATRICS AND INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:W
Authorized Official - Last Name:HOOYMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-757-0012
Mailing Address - Street 1:3535 S LAFAYETTE ST
Mailing Address - Street 2:#203
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3957
Mailing Address - Country:US
Mailing Address - Phone:303-757-0012
Mailing Address - Fax:303-757-0165
Practice Address - Street 1:3535 S LAFAYETTE ST
Practice Address - Street 2:#203
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3957
Practice Address - Country:US
Practice Address - Phone:303-757-0012
Practice Address - Fax:303-757-0165
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-22
Last Update Date:2010-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO44453207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO22436341Medicaid
CO22436341Medicaid
COA10412Medicare UPIN