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General NPI Number Information
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NPI Number | 1467067702
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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 | 09/14/2020
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Last Update Date | 09/14/2020
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Provider Practice Location Address
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Address Line | 1551 PROFESSIONAL LN UNIT 280
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City | LONGMONT
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State | CO
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Zip | 80501-6965
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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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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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