1992064315 NPI number — AVISTA WOMENS CARE

Table of content: ERNO J. GYETVAI MD (NPI 1356429013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992064315 NPI number — AVISTA WOMENS CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AVISTA WOMENS CARE
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:
1992064315
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
90 HEALTH PARK DR
Provider Second Line Business Mailing Address:
SUITE 290
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80027-9757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-439-8910
Provider Business Mailing Address Fax Number:
303-439-9134

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
611 MITCHELL WAY
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
ERIE
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80516-5436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-439-8910
Provider Business Practice Location Address Fax Number:
303-439-9134
Provider Enumeration Date:
05/04/2012

Additional Information

Authorized Official

Authorized Official Last Name:
HANCOCK
Authorized Official First Name:
PAULA
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS MANAGER
Authorized Official Telephone Number:
303-439-8910

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)





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