Basic Information
Provider Information | |||||||||
NPI: | 1972127959 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | OB-GYN AFFILIATES | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | ASSOCIATES IN WOMEN'S HEALTH | ||||||||
OtherOrganizationType: | 5 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1745 SHEA CENTER DR STE 400 | ||||||||
Address2: |   | ||||||||
City: | HIGHLANDS RANCH | ||||||||
State: | CO | ||||||||
PostalCode: | 801291540 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7203074456 | ||||||||
FaxNumber: | 3034791004 | ||||||||
Practice Location | |||||||||
Address1: | 2801 YOUNGFIELD ST STE 200 | ||||||||
Address2: |   | ||||||||
City: | GOLDEN | ||||||||
State: | CO | ||||||||
PostalCode: | 804012202 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3039401867 | ||||||||
FaxNumber: | 3039401894 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/04/2020 | ||||||||
LastUpdateDate: | 06/08/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | FOELSKE | ||||||||
AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | AUTHORIZED REPRESENTATIVE | ||||||||
AuthorizedOfficialTelephone: | 7203074456 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | OB-GYN AFFILIATES | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/08/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |   |
No ID Information.