=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659553675
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GEORGE V ROSSIE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2007
-----------------------------------------------------
Last Update Date | 03/06/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4200 W CONEJOS PL STE 111
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80204-1309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-893-9300
-----------------------------------------------------
Fax | 303-893-4384
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4200 W CONEJOS PL STE 111
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80204-1309
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-893-9300
-----------------------------------------------------
Fax | 303-893-4384
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | MS. DAUN GRETZINGER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 303-893-9300
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 799
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------