Provider Demographics
NPI:1861438368
Name:EDWIN J. LOEFFEL JR., MD, PC
Entity type:Organization
Organization Name:EDWIN J. LOEFFEL JR., MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE CONTACT
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-587-1213
Mailing Address - Street 1:1000 RUSH DR
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201-9627
Mailing Address - Country:US
Mailing Address - Phone:719-530-8218
Mailing Address - Fax:970-667-0847
Practice Address - Street 1:1000 RUSH DR
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201-9627
Practice Address - Country:US
Practice Address - Phone:719-530-8218
Practice Address - Fax:970-667-0847
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01191501Medicaid
COCG2959OtherRAILROAD MEDICARE
COCG2959OtherRAILROAD MEDICARE