Healthcare Provider Details

I. General information

NPI: 1821759648
Provider Name (Legal Business Name): OBSTETRIX MEDICAL GROUP OF COLORADO, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2022
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10465 PARK MEADOWS DR STE 201
LONE TREE CO
80124-5321
US

IV. Provider business mailing address

PO BOX 840532
DALLAS TX
75284-0532
US

V. Phone/Fax

Practice location:
  • Phone: 303-790-1515
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code2080P0206X
TaxonomyPediatric Gastroenterology Physician
License Number
License Number State

VIII. Authorized Official

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