1164089678 NPI number — ANNE W ESTARES DO PC

Table of content: (NPI 1164089678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164089678 NPI number — ANNE W ESTARES DO PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANNE W ESTARES DO PC
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:
1164089678
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5495 CREIGHTON CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80918-8158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-314-5254
Provider Business Mailing Address Fax Number:
719-439-9500

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5901 CORPORATE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80919-1941
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-314-5254
Provider Business Practice Location Address Fax Number:
719-439-9500
Provider Enumeration Date:
05/21/2019

Additional Information

Authorized Official

Authorized Official Last Name:
ESTARES
Authorized Official First Name:
ANNE
Authorized Official Middle Name:
WIERMAN
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
719-599-7949

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DR.0051694 . This is a "DOCTOR OF OSTEOPATHIC MEDICINE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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