1245854405 NPI number — OBSTETRIX MEDICAL GROUP OF COLORADO, P.C.

Table of content: (NPI 1245854405)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245854405 NPI number — OBSTETRIX MEDICAL GROUP OF COLORADO, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OBSTETRIX MEDICAL GROUP OF 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:
ROCKY MOUNTAIN PEDIATRIC CARDIOLOGY
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:
1245854405
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 CONCORD TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUNRISE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33323-2843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-243-3839
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
180 S FRONTAGE RD W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VAIL
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81657-5038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-479-7278
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/03/2020

Additional Information

Authorized Official

Authorized Official Last Name:
CHEN
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSISTANT SECRETARY
Authorized Official Telephone Number:
800-243-3839

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0008X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080P0205X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0208X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0804X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 44500351 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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