=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730348517
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | H&A MEDICAL MANAGEMENT
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/05/2008
-----------------------------------------------------
Last Update Date | 06/05/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1006 ROBERTSON ST STE 204
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80524-3948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-482-3820
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1006 ROBERTSON ST STE 204
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80524-3948
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-482-3820
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER/OWNER
-----------------------------------------------------
Name | HARSHAN KALATARDI
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 720-254-7095
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------