Healthcare Provider Details

I. General information

NPI: 1295798270
Provider Name (Legal Business Name): OBSTETRIX MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 19TH AVE #5050
DENVER CO
80218-1216
US

IV. Provider business mailing address

2600 GARDEN LN
GREENWOOD VILLAGE CO
80121-1624
US

V. Phone/Fax

Practice location:
  • Phone: 303-860-9990
  • Fax: 303-839-7761
Mailing address:
  • Phone: 720-493-5113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number31587
License Number StateCO

VIII. Authorized Official

Name: MRS. LINDA BLAKE
Title or Position: OFFICE MANAGER
Credential:
Phone: 303-860-9990