NPI |
1013679877 |
The last name of the provider. If the provider is an individual, this is the legal name. |
Entity Type Code |
2 |
The first name of the provider, if the provider
is an individual. |
Employer Identification Number EIN |
|
The middle name of the provider, if the provider
is an individual. |
Provider Organization Name Legal Business Name |
DIRECT DIABETES CONSULTANTS LLC |
The name prefix or salutation of the provider
if the provider is an individual; for example, Mr., Mrs., or Corporal. |
Provider First Line Business Practice Location Address |
1700 BASSETT APT 1603 |
The abbreviations for professional degrees or credentials used or held by the provider,
if the provider is an individual. Examples
are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations
will not be verified by NPS. |
Provider Business Practice Location Address City Name |
DENVER |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
CO |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address Postal Code |
80202 |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider Business Practice Location Address Telephone Number |
7207390734 |
The telephone number associated with the location address of the provider being identified. |
Provider Enumeration Date |
10/8/2021 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
10/8/2021 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Authorized Official Last Name |
CULLAN |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Authorized Official First Name |
JARROD |
The first name of the authorized official. |
Authorized Official Middle Name |
M |
The middle name of the authorized official. |
Authorized Official Title or Position |
MANAGING DIRECTOR |
The title or position of the authorized official. |
Authorized Official Telephone Number |
7207390734 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
207R00000X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Organization Subpart |
N |
|
Authorized Official Name Prefix Text |
DR. |
|
Authorized Official Credential Text |
MD |
|
Healthcare Provider Taxonomy Group 1 |
193400000X SINGLE SPECIALTY GROUP |
|
NPI Certification Date |
10/3/2021 |
|