Active NPI
Tina-Marie Thiebaut
- Internal Medicine Physician
- Wheat Ridge, CO
National Provider Identifier
1194869818
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 98117
- Practice address
- 4803 Ward Rd
Wheat Ridge, CO 80033-1902 - Phone
- (303) 743-5855
- NPI assigned
- Feb 16, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 98117 | CO | Primary |
Addresses
Primary practice location
4803 Ward Rd
Wheat Ridge, CO 80033-1902
Mailing address
13272 Columbine CT
Thornton, CO 80241-2072
Phone (303) 280-2496
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 006717 | Other | KAISER-COMMERCIAL NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 98117 | CO | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1194869818",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13272 COLUMBINE CT",
"city": "THORNTON",
"state": "CO",
"postal_code": "802412072",
"telephone_number": "303-280-2496"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4803 WARD RD",
"city": "WHEAT RIDGE",
"state": "CO",
"postal_code": "800331902",
"telephone_number": "303-743-5855"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THIEBAUT",
"first_name": "TINA-MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-02-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "CO",
"license": "98117",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "KAISER-COMMERCIAL NUMBER",
"identifier": "006717",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Wheat Ridge, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.