1457514739 NPI number — COLORADO WOMEN'S HEALTHCARE INC

Table of content: (NPI 1457514739)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457514739 NPI number — COLORADO WOMEN'S HEALTHCARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLORADO WOMEN'S HEALTHCARE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GRACE CHENG
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457514739
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1550 SOUT POTOMAC ST
Provider Second Line Business Mailing Address:
SUITE 135
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80012-9998
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-745-8888
Provider Business Mailing Address Fax Number:
303-369-1062

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1550 S POTOMAC ST
Provider Second Line Business Practice Location Address:
SUITE 135
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80012-5455
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-745-8888
Provider Business Practice Location Address Fax Number:
303-369-1062
Provider Enumeration Date:
07/07/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHENG
Authorized Official First Name:
GRACE
Authorized Official Middle Name:
YUN
Authorized Official Title or Position:
OWNER OPERATOR
Authorized Official Telephone Number:
30374588888

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  37990 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 70823774 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".