Basic Information
| Provider Information | |||||||||
| NPI: | 1801842463 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CONTEMPORARY CARE FOR WOMEN PLLC | ||||||||
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| OtherOrganizationName: | CENTER FOR WOMEN'S HEALTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1715 61ST AVE | ||||||||
| Address2: | |||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806347989 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703361500 | ||||||||
| FaxNumber: | 9703361505 | ||||||||
| Practice Location | |||||||||
| Address1: | 1715 61ST AVE | ||||||||
| Address2: | |||||||||
| City: | GREELEY | ||||||||
| State: | CO | ||||||||
| PostalCode: | 806347989 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9703361500 | ||||||||
| FaxNumber: | 9703361505 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/25/2006 | ||||||||
| LastUpdateDate: | 07/20/2009 | ||||||||
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| AuthorizedOfficialLastName: | ABBOT | ||||||||
| AuthorizedOfficialFirstName: | STEWART | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9703361500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 28859855 | 05 | CO | MEDICAID |