Healthcare Provider Details

I. General information

NPI: 1356458640
Provider Name (Legal Business Name): EMMETT L MCGUIRE MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2006
Last Update Date: 07/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E HAMPDEN AVE
ENGLEWOOD CO
80113-2702
US

IV. Provider business mailing address

PO BOX 909
COLORADO SPRINGS CO
80901-0909
US

V. Phone/Fax

Practice location:
  • Phone: 303-788-5300
  • Fax:
Mailing address:
  • Phone: 719-576-4171
  • Fax: 719-592-1645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number41071
License Number StateCO

VIII. Authorized Official

Name: EMMETT LONO MCGUIRE
Title or Position: OWNER
Credential: M.D.
Phone: 303-788-5300