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General NPI Number Information
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NPI Number | 1992064315
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Entity Type | Organization
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Legal Business Name | AVISTA WOMENS CARE
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Dates
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Enumeration Date | 05/04/2012
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Last Update Date | 05/04/2012
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Provider Practice Location Address
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Address Line | 611 MITCHELL WAY SUITE 103
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City | ERIE
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State | CO
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Zip | 80516-5436
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Country | US
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Telephone | 303-439-8910
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Fax | 303-439-9134
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Provider Business Mailing Address
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Address Line | 90 HEALTH PARK DR SUITE 290
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City | LOUISVILLE
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State | CO
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Zip | 80027-9757
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Country | US
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Telephone | 303-439-8910
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Fax | 303-439-9134
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MS. PAULA HANCOCK
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Credential |
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Telephone | 303-439-8910
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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