Provider Demographics
NPI:1447466073
Name:MAYFAIR INTERNAL MEDICINE, P.C.
Entity type:Organization
Organization Name:MAYFAIR INTERNAL MEDICINE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PARTNER
Authorized Official - Prefix:MS
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:SARAH
Authorized Official - Last Name:LOVEGREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-333-6434
Mailing Address - Street 1:6311 E 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-2821
Mailing Address - Country:US
Mailing Address - Phone:303-333-6434
Mailing Address - Fax:303-333-6505
Practice Address - Street 1:6311 E 14TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-2821
Practice Address - Country:US
Practice Address - Phone:303-333-6434
Practice Address - Fax:303-333-6505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04016044Medicaid
COMACOtherGROUP BLUE CROSS BLUE SHI
COCC5508Medicare ID - Type UnspecifiedGROUP MEDICARE
COD24470Medicare UPIN
COH10932Medicare UPIN
COF60732Medicare UPIN
COMACOtherGROUP BLUE CROSS BLUE SHI