=====================================================
General NPI Number Information
=====================================================
NPI Number | 1770749475
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEDIATRIC ENDOCRINOLOGY OF COLORADO PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2008
-----------------------------------------------------
Last Update Date | 10/18/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7780 S BROADWAY SUITE 250
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80122-2648
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-649-9972
-----------------------------------------------------
Fax | 303-649-9973
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 630258
-----------------------------------------------------
City | HIGHLANDS RANCH
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80163-0258
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-649-9972
-----------------------------------------------------
Fax | 303-649-9973
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. STEPHANIE C. HSU
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 303-649-9972
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | DR45467
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------