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General NPI Number Information
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NPI Number | 1043720600
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Entity Type | Organization
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Legal Business Name | WESTERN INFECTIOUS DISEASE CONSULTANTS, P.C.
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Dates
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Enumeration Date | 10/09/2017
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Last Update Date | 10/09/2017
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Provider Practice Location Address
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Address Line | 2030 MOUNTAIN VIEW AVE STE 540
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City | LONGMONT
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State | CO
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Zip | 80501-3183
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Country | US
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Telephone | 303-425-9245
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Fax | 720-630-8591
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Provider Business Mailing Address
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Address Line | PO BOX 1449
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City | WHEAT RIDGE
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State | CO
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Zip | 80034-1449
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Country | US
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Telephone | 303-425-9245
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Fax | 303-425-1378
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | RUTH M SMITH
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Credential |
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Telephone | 303-425-9245
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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