Healthcare Provider Details
I. General information
NPI: 1467498436
Provider Name (Legal Business Name): ASSOCIATES IN WOMEN'S CARE, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 06/20/2006
Last Update Date: 07/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
6011 E. WOODMEN RD., SUITE 320
COLORADO SPRINGS CO
80923
US
IV. Provider business mailing address
6011 E. WOODMEN RD., SUITE 320
COLORADO SPRINGS CO
80923
US
V. Phone/Fax
- Phone: 719-591-6666
- Fax: 719-573-0731
- Phone: 719-591-6666
- Fax: 719-573-0731
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 207V00000X |
| Taxonomy | Obstetrics & Gynecology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
BRENT
DELEATH
SHELTON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 719-591-6666