Provider Demographics
NPI:1720139868
Name:INTERNAL MEDICINE ASSOC. OF WHEAT RIDGE, P.C.
Entity type:Organization
Organization Name:INTERNAL MEDICINE ASSOC. OF WHEAT RIDGE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:MR
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:DOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-422-3727
Mailing Address - Street 1:1805 KIPLING ST.
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215
Mailing Address - Country:US
Mailing Address - Phone:303-422-3727
Mailing Address - Fax:303-467-9354
Practice Address - Street 1:1805 KIPLING ST.
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80215
Practice Address - Country:US
Practice Address - Phone:303-422-3727
Practice Address - Fax:303-467-9354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2010-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01206127Medicaid
CO01289115Medicaid
CO01346295Medicaid
CO01351261Medicaid
CO01317775Medicaid
CO286218Medicare ID - Type Unspecified
CO286228Medicare ID - Type Unspecified
CO01206127Medicaid
COG31160Medicare UPIN
CO268278Medicare ID - Type Unspecified
CO01346295Medicaid
CO01289115Medicaid
COF01024Medicare UPIN
CO286248Medicare ID - Type Unspecified
CO286238Medicare ID - Type Unspecified
CO01351261Medicaid