Provider Demographics
NPI:1730333683
Name:EXEMPLA DIABETES CENTER
Entity type:Organization
Organization Name:EXEMPLA DIABETES CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIABETES EDUCATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:AMY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:BRADSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:RD, CDE
Authorized Official - Phone:303-403-7930
Mailing Address - Street 1:3455 LUTHERAN PKWY STE 270
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6034
Mailing Address - Country:US
Mailing Address - Phone:303-403-7930
Mailing Address - Fax:303-403-7945
Practice Address - Street 1:3455 LUTHERAN PKWY
Practice Address - Street 2:SUITE 270
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6028
Practice Address - Country:US
Practice Address - Phone:303-403-7930
Practice Address - Fax:303-403-7945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0012680281P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes281P00000XHospitalsChronic Disease Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO05608006Medicaid