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THOMAS LAVERNE BACHINSKI PAC
>> Physician Assistant >> Physician Assistants & Advanced Practice Nursing ProvidersRegistrant NPI Number: 1679654909
Individual Registrant:
THOMAS LAVERNE BACHINSKI PAC
Gender: M
Not Sole Proprietor
Location and contact information for practice:
2101 KEN PRATT BLVD SUITE 104 LONGMONT, CO 80501-6567 US
Tel: 303-415-4157 Fax: 303-776-3102
Contact information for business:
5450 WESTERN AVE SUITE B BOULDER, CO 80301-2709 US
Tel: 303-415-4770 Fax: 303-415-4769
Registration Information:
NPI: 1679654909
Entity Type: Individual
Specialty information:
Primary | Code | Category/Description | State | License Number |
---|
N | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers Physician Assistant
| CO | PA.0000246 |
Y | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers Physician Assistant | CO | PA.0000246 |
Legacy codes, insurance codes and state license numbers:
Issuer | Number | State | Type |
---|
| 07002462 | CO | 05 |
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