Healthcare Provider Details

I. General information

NPI: 1659995603
Provider Name (Legal Business Name): OBSTETRIX MEDICAL GROUP OF COLORADO, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 06/10/2024
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 RIDGEGATE PKWY
LONE TREE CO
80124-5522
US

IV. Provider business mailing address

4722 N 24TH ST STE 150
PHOENIX AZ
85016-4860
US

V. Phone/Fax

Practice location:
  • Phone: 720-225-1000
  • Fax:
Mailing address:
  • Phone: 877-737-4546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: LINDA CHEN
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 800-243-3839