=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346524428
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REGENTS OF UNIVERSITY OF COLORADO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/06/2011
-----------------------------------------------------
Last Update Date | 10/06/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1999 N FITZSIMONS PKWY 120
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80045-7503
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-344-1292
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1800 GRANT ST SUITE 600
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80203-1185
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-724-0882
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DEAN
-----------------------------------------------------
Name | DR. RICHARD C KRUGMAN
-----------------------------------------------------
Credential | M..D.
-----------------------------------------------------
Telephone | 303-724-0882
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 291U00000X
-----------------------------------------------------
Taxonomy Name | Clinical Medical Laboratory
-----------------------------------------------------
License Number | 207ND0900X
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------