Healthcare Provider Details

I. General information

NPI: 1275591281
Provider Name (Legal Business Name): FORT COLLINS WOMEN'S CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 05/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 S LEMAY AVE SUITE 300
FORT COLLINS CO
80524-3957
US

IV. Provider business mailing address

1107 S LEMAY AVE SUITE 300
FORT COLLINS CO
80524-3955
US

V. Phone/Fax

Practice location:
  • Phone: 970-493-7442
  • Fax: 970-493-2990
Mailing address:
  • Phone: 970-493-7442
  • Fax: 970-493-2990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT KENYON
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 970-493-7442