Healthcare Provider Details

I. General information

NPI: 1972127876
Provider Name (Legal Business Name): OB-GYN AFFILIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2020
Last Update Date: 06/08/2020
Certification Date: 06/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10107 RIDGEGATE PKWY SUITE 320
LONE TREE CO
80124-5532
US

IV. Provider business mailing address

1745 SHEA CENTER DR STE 400
HIGHLANDS RANCH CO
80129-1540
US

V. Phone/Fax

Practice location:
  • Phone: 303-795-0890
  • Fax: 303-795-3568
Mailing address:
  • Phone: 720-307-4456
  • Fax: 303-479-1004

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: ELIZABETH FOELSKE
Title or Position: AUTHORIZED REPRESENTATIVE
Credential:
Phone: 720-307-4456