Basic Information
| Provider Information | |||||||||
| NPI: | 1689788192 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOMENS CLINIC OF THE PLAINS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 LINCOLN ST # 230 | ||||||||
| Address2: | |||||||||
| City: | FORT MORGAN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 807013210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9705420930 | ||||||||
| FaxNumber: | 9705420934 | ||||||||
| Practice Location | |||||||||
| Address1: | 3464 S WILLOW ST # 555 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802314531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3037552900 | ||||||||
| FaxNumber: | 3037550404 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2006 | ||||||||
| LastUpdateDate: | 11/02/2007 | ||||||||
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| AuthorizedOfficialLastName: | SORIANO | ||||||||
| AuthorizedOfficialFirstName: | MICHELLE | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9705420930 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 38136 | CO | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 94789746 | 05 | CO | MEDICAID | DF8550 | 01 | CO | RAILROAD MEDICARE | OTHER | 38136 | 01 | CO | STATE LICENSE | OTHER |