Basic Information
| Provider Information | |||||||||
| NPI: | 1861726515 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED UROGYNECOLOGY & PELVIC SURGERY, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | KEIL UROGYNECOLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4500 E 9TH AVE | ||||||||
| Address2: | SUITE 420 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802203900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033295822 | ||||||||
| FaxNumber: | 3033297934 | ||||||||
| Practice Location | |||||||||
| Address1: | 4500 E 9TH AVE | ||||||||
| Address2: | SUITE 420 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802203900 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033295822 | ||||||||
| FaxNumber: | 3033297934 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2009 | ||||||||
| LastUpdateDate: | 09/29/2009 | ||||||||
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| AuthorizedOfficialLastName: | KEIL | ||||||||
| AuthorizedOfficialFirstName: | KRISTINELL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3033295822 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | 35161 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 01351618 | 05 | CO | MEDICAID |