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General NPI Number Information
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NPI Number | 1497922066
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Entity Type | Organization
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Legal Business Name | ST. VRAIN OB-GYN ASSOCIATES, P.C.
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Dates
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Enumeration Date | 05/13/2008
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Last Update Date | 05/13/2008
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Provider Practice Location Address
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Address Line | 2030 MOUNTAIN VIEW AVE STE 440
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City | LONGMONT
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State | CO
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Zip | 80501-3182
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Country | US
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Telephone | 303-772-7880
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Fax | 303-709-5790
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Provider Business Mailing Address
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Address Line | 2030 MOUNTAIN VIEW AVE STE 440
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City | LONGMONT
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State | CO
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Zip | 80501-3182
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Country | US
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Telephone | 303-772-7880
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Fax | 303-709-5790
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Authorized Official
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Title or Position | OWNER
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Name | DR. RUSSELL GEORGE REITINGER
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Credential | M.D.
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Telephone | 303-772-7880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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