Healthcare Provider Details

I. General information

NPI: 1689841868
Provider Name (Legal Business Name): LONGMONT HOSPITALIST GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 09/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 MOUNTAIN VIEW AVE SUITE 540
LONGMONT CO
80501-3178
US

IV. Provider business mailing address

2030 MOUNTAIN VIEW AVE SUITE 540
LONGMONT CO
80501-3178
US

V. Phone/Fax

Practice location:
  • Phone: 303-951-4059
  • Fax: 303-951-4060
Mailing address:
  • Phone: 303-951-4059
  • Fax: 303-951-4060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN LUCAS HUTCHISON
Title or Position: ADMINISTRATOR
Credential:
Phone: 30348010129