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General NPI Number Information
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NPI Number | 1467526186
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Entity Type | Organization
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Legal Business Name | WHEAT RIDGE GENERAL AND VASCULAR SURGICAL ASSOCIATES PC
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 02/17/2010
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Provider Practice Location Address
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Address Line | 7805 W 38TH AVE
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City | WHEAT RIDGE
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State | CO
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Zip | 80033-6109
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Country | US
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Telephone | 303-431-2900
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Fax | 303-431-2999
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Provider Business Mailing Address
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Address Line | 7805 W 38TH AVE
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City | WHEAT RIDGE
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State | CO
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Zip | 80033-6109
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Country | US
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Telephone | 303-431-2900
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Fax | 303-431-2999
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Authorized Official
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Title or Position | SECRETARY
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Name | LISA A DEFEYTER
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Credential |
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Telephone | 303-431-2900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 29993
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License Number State | CO
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