MEDICARE: RUTH ANITA VANDERKOOI MD

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	207Q00000X	Family Medicine Physician	31315	CO

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

General Provider Information

NPI Number	:	1174567861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RUTH ANITA VANDERKOOI MD

Provider Business Mailing Address
First Line	:	500 ELDORADO BLVD # 6250
Second Line	:
City	:	BROOMFIELD
State	:	CO
Zip	:	80021-3408
Country	:	US
Telephone Number	:	303-272-0751
Fax Number	:	303-318-2488

Provider Business Practice Location Address
First Line	:	8350 WCR 13 UNIT 160
Second Line	:
City	:	FIRESTONE
State	:	CO
Zip	:	80504-6803
Country	:	US
Telephone Number	:	303-689-5160
Fax Number	:	303-689-5175

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2006
Last Update Date	:	01/15/2013

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