Healthcare Provider Details

I. General information

NPI: 1295359180
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: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 CENTRAL PARK DR
STEAMBOAT SPRINGS CO
80487-8813
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 970-879-1322
  • Fax:
Mailing address:
  • Phone: 877-737-4546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number
License Number State

VIII. Authorized Official

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