Basic Information
| Provider Information | |||||||||
| NPI: | 1568711141 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHAMPION | ||||||||
| FirstName: | KASEY | ||||||||
| MiddleName: | ROWE | ||||||||
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| OtherLastName: | CHAMPION | ||||||||
| OtherFirstName: | KASEY | ||||||||
| OtherMiddleName: | ROWE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 172328 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802172328 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036952628 | ||||||||
| FaxNumber: | 3033067753 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 S POTOMAC ST | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036952628 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/29/2012 | ||||||||
| LastUpdateDate: | 08/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 148561 | CA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | MD61138717 | WA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | DR.0060303 | CO | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.