=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740310622
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MEGAN SHANA FOSS PA-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/07/2007
-----------------------------------------------------
Last Update Date | 05/03/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5265 N ACADEMY BLVD SUITE 1800
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80918-4060
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-599-0444
-----------------------------------------------------
Fax | 719-599-8809
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2695 ROCKY MOUNTAIN AVE STE 150
-----------------------------------------------------
City | LOVELAND
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80538-9071
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-624-4443
-----------------------------------------------------
Fax | 970-490-4175
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 1461
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------