Basic Information
| Provider Information | |||||||||
| NPI: | 1568507242 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OATIS | ||||||||
| FirstName: | WENDY | ||||||||
| MiddleName: | S. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 W US HIGHWAY 50 | ||||||||
| Address2: | SUITE 160 | ||||||||
| City: | SALIDA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 812012238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195302048 | ||||||||
| FaxNumber: | 7195302055 | ||||||||
| Practice Location | |||||||||
| Address1: | 525 N FOOTE AVENUE | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809104561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193656568 | ||||||||
| FaxNumber: | 7193656317 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2007 | ||||||||
| LastUpdateDate: | 01/28/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/28/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | DR-49157 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 83103554 | 05 | CO | MEDICAID |