Provider Demographics
NPI:1427293471
Name:C.J. TSAMASFYROS, M.D. LLC
Entity type:Organization
Organization Name:C.J. TSAMASFYROS, M.D. LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANTINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:TSAMASFYROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-322-2005
Mailing Address - Street 1:4500 E 9TH AVE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3912
Mailing Address - Country:US
Mailing Address - Phone:303-322-2005
Mailing Address - Fax:303-322-4408
Practice Address - Street 1:4500 E 9TH AVE
Practice Address - Street 2:SUITE 220
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3912
Practice Address - Country:US
Practice Address - Phone:303-322-2005
Practice Address - Fax:303-322-4408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-04
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO17165173000000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COD23206OtherUPIN
17165OtherCO LICENSE
CO1171651Medicaid
CO6498090001Medicare NSC
CE5718Medicare UPIN