NPIMap

Organization Active NPI

Made LLC

  • Surgical Physician Assistant
  • Thornton, CO
National Provider Identifier
1366784167
Registry record updated Mar 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
1520 Issued in CO
Legal business name
MADE LLC
Practice address
1882 E 104TH Ave Unit 936
Thornton, CO 80233-4336
Phone
(720) 363-3145
Fax
(720) 381-6313
NPI assigned
Mar 20, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 20, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lawrence Davis, CSFANPI 1275850802
Title
Cert. Surg First Assist
Phone
(720) 363-3145

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Physician AssistantGroup: 193400000X SINGLE SPECIALTY GROUP 363AS0400X 1520 CO Primary

Addresses

Primary practice location

1882 E 104TH Ave Unit 936
Thornton, CO 80233-4336

Mailing address

1882 E 104TH Ave Unit 936
Thornton, CO 80233-4336
Phone (720) 363-3145

Other identifiers 1

IdentifierTypeStateIssuer
010801006OtherCOCOLORADO DRIVERS LICENSE

Other names 1

  • Lawrence A. Davis Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lawrence a Davis2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1363737600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1363737600000",
    "number": "1366784167",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1882 E 104TH AVE UNIT 936",
            "city": "THORNTON",
            "state": "CO",
            "postal_code": "802334336",
            "telephone_number": "720-363-3145",
            "fax_number": "720-381-6313"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1882 E 104TH AVE UNIT 936",
            "city": "THORNTON",
            "state": "CO",
            "postal_code": "802334336",
            "telephone_number": "720-363-3145",
            "fax_number": "720-381-6313"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MADE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-03-20",
        "last_updated": "2013-03-20",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "LAWRENCE",
        "authorized_official_title_or_position": "CERT. SURG FIRST ASSIST",
        "authorized_official_telephone_number": "720-363-3145",
        "authorized_official_credential": "CSFA"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Physician Assistant, Surgical",
            "state": "CO",
            "license": "1520",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "COLORADO DRIVERS LICENSE",
            "identifier": "010801006",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lawrence A. Davis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Thornton, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.