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1902889967

NPI Code Detail

MEDICARE: HENRY RAY LANDSGAARD

MEDICARE: HENRY RAY LANDSGAARD

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	207P00000X	Emergency Medicine Physician	5101011929	MI
2	207P00000X	Emergency Medicine Physician	DR.0055268	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00065018	OTHER	MI	RAILROAD MEDICARE PIN

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	HL011929	OTHER		BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1902889967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HENRY RAY LANDSGAARD

Provider Business Mailing Address
First Line	:	PO BOX 912215
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80291-2215
Country	:	US
Telephone Number	:	303-306-7783
Fax Number	:	303-306-7753

Provider Business Practice Location Address
First Line	:	1024 S LEMAY AVE
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-3929
Country	:	US
Telephone Number	:	970-495-7000
Fax Number	:	303-306-7753

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

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	06/29/2015

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Directions to “ HENRY RAY LANDSGAARD ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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