Healthcare Provider Details

I. General information

NPI: 1033200571
Provider Name (Legal Business Name): PATRICIA M AL-ADSANI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 11/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8360 WHITE OWL CT
WINDSOR CO
80550-8051
US

IV. Provider business mailing address

8360 WHITE OWL CT
WINDSOR CO
80550-8051
US

V. Phone/Fax

Practice location:
  • Phone: 970-674-3153
  • Fax: 970-336-5000
Mailing address:
  • Phone: 970-674-3153
  • Fax: 970-336-5000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number04-24359
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number31456
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number31456
License Number StateIA
# 4
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number50327
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier100128760B
Identifier TypeMEDICAID
Identifier StateKS
Identifier Issuer
# 2
Identifier0249649
Identifier TypeMEDICAID
Identifier StateIA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: