1497843916 NPI number — OBSTETRIX MEDICAL GROUP OF CO

Table of content: (NPI 1497843916)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497843916 NPI number — OBSTETRIX MEDICAL GROUP OF CO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OBSTETRIX MEDICAL GROUP OF CO
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:
Provider Other Organization Name Type Code:
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:
1497843916
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1460 UPPER BEAR CREEK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVERGREEN
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80439-4241
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-674-6949
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 E 19TH AVE STE 5050
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80218-1200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-860-9990
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/10/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
MARY
Authorized Official Middle Name:
PAGE
Authorized Official Title or Position:
NURSE PRACTITIONER
Authorized Official Telephone Number:
303-860-9990

Provider Taxonomy Codes

  • Taxonomy code: 363LP1700X , with the licence number:  100795 , 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)