Healthcare Provider Details

I. General information

NPI: 1508957242
Provider Name (Legal Business Name): OBSTETRIX MEDICAL GROUP OF CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15382 W 73RD PL
ARVADA CO
80007-7866
US

IV. Provider business mailing address

15382 W 73RD PL
ARVADA CO
80007-7866
US

V. Phone/Fax

Practice location:
  • Phone: 303-422-3094
  • Fax:
Mailing address:
  • Phone: 303-422-3094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP1700X
TaxonomyPerinatal Nurse Practitioner
License Number66932
License Number StateCO

VIII. Authorized Official

Name: MRS. BARBARA JOAN MCCABE
Title or Position: NURSE PRACTITIONER
Credential: CNP
Phone: 303-860-9990