MEDICARE: ST. VRAIN OB-GYN ASSOCIATES, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist

General Provider Information

NPI Number	:	1497922066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. VRAIN OB-GYN ASSOCIATES, P.C.

Provider Business Mailing Address
First Line	:	2030 MOUNTAIN VIEW AVE STE 440
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80501-3182
Country	:	US
Telephone Number	:	303-772-7880
Fax Number	:	303-709-5790

Provider Business Practice Location Address
First Line	:	2030 MOUNTAIN VIEW AVE STE 440
Second Line	:
City	:	LONGMONT
State	:	CO
Zip	:	80501-3182
Country	:	US
Telephone Number	:	303-772-7880
Fax Number	:	303-709-5790

Authorized Official
Title or Position	:	OWNER
Name	:	DR. RUSSELL GEORGE REITINGER
Credential	:	M.D.
Telephone Number	:	303-772-7880

Provider Enumeration Date	:	05/13/2008
Last Update Date	:	05/13/2008

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