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Contact Information

DERMATOLOGY AND ENDOCRINOLOGY LLC
1925 E ORMAN AVE
STE 115
PUEBLO, CO81004-3500
 Phone: 719-564-4500
 Fax: 719-564-0304
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Dermatology

207N00000X 07 Physician/Dermatology
 

Endocrinology, Diabetes & Metabolism

207RE0101X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for DERMATOLOGY AND ENDOCRINOLOGY LLC

NPI Number 1114999018
LBN Legal business name DERMATOLOGY AND ENDOCRINOLOGY LLC
Authorized official KIM DERNOVSEK - (OWNER)
Entity Organization
Organization subpart 1 No
Enumeration date 02/03/2006
Last updated 01/11/2016 - About 10 years ago
Identifiers
CO License # 26083
CO License # 26084
CO Medicaid 96378352
CO Other 1114999018 RAILROAD MEDICARE
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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