Healthcare Provider Details

I. General information

NPI: 1457612848
Provider Name (Legal Business Name): AMANDA O'STEEN BABCOCK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA O'STEEN MD

II. Dates (important events)

Enumeration Date: 06/02/2012
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 SUPERIOR DR STE 100B
SUPERIOR CO
80027-8653
US

IV. Provider business mailing address

PO BOX 9049
BOULDER CO
80301-9049
US

V. Phone/Fax

Practice location:
  • Phone: 303-415-8940
  • Fax: 303-425-9259
Mailing address:
  • Phone: 303-415-8940
  • Fax: 303-425-9259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA127022
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberDR.0061542
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2023000976
License Number StateMO
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0061542
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: