MEDICARE: ST JOSEPH EKG READER PANEL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician
2	207RC0000X	Cardiovascular Disease Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CG2301	OTHER	CO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	STT4508	OTHER	CO	BLUE SHIELD

General Provider Information

NPI Number	:	1154389450
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST JOSEPH EKG READER PANEL

Provider Business Mailing Address
First Line	:	3464 S WILLOW ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-4531
Country	:	US
Telephone Number	:	303-755-2900
Fax Number	:	303-755-0404

Provider Business Practice Location Address
First Line	:	1835 FRANKLIN ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-1126
Country	:	US
Telephone Number	:	303-755-2900
Fax Number	:

Authorized Official
Title or Position	:	MD
Name	:	WILLIAM NELSON
Credential	:
Telephone Number	:	303-755-2900

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	10/29/2007

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Directions to “ST JOSEPH EKG READER PANEL ” Practice Location

Language	Start Address	Practice Location

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