1538100375 NPI number — WOMENS HEALTHCARE OF WESTERN COLORADO, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538100375 NPI number — WOMENS HEALTHCARE OF WESTERN COLORADO, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOMENS HEALTHCARE OF WESTERN COLORADO, P.C.
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:
1538100375
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2525 NORTH 8TH ST.
Provider Second Line Business Mailing Address:
STE 202
Provider Business Mailing Address City Name:
GRAND JUNCTION
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
81501-8847
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-245-1168
Provider Business Mailing Address Fax Number:
970-242-4299

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2525 NORTH 8TH ST
Provider Second Line Business Practice Location Address:
STE 202
Provider Business Practice Location Address City Name:
GRAND JUNCTION
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-245-1168
Provider Business Practice Location Address Fax Number:
970-242-4299
Provider Enumeration Date:
06/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ESTRIDGE
Authorized Official First Name:
MJ
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
970-248-3702

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 04007316 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com