Healthcare Provider Details

I. General information

NPI: 1497843916
Provider Name (Legal Business Name): OBSTETRIX MEDICAL GROUP OF CO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

1601 E 19TH AVE STE 5050
DENVER CO
80218-1200
US

IV. Provider business mailing address

1460 UPPER BEAR CREEK RD
EVERGREEN CO
80439-4241
US

V. Phone/Fax

Practice location:
  • Phone: 303-860-9990
  • Fax:
Mailing address:
  • Phone: 303-674-6949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP1700X
TaxonomyPerinatal Nurse Practitioner
License Number100795
License Number StateCO

VIII. Authorized Official

Name: MRS. MARY PAGE SMITH
Title or Position: NURSE PRACTITIONER
Credential: CNP
Phone: 303-860-9990