MEDICARE: DENVER-EVERGREEN OB-GYN GRP., PC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689672610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENVER-EVERGREEN OB-GYN GRP., PC

Provider Business Mailing Address
First Line	:	425 S CHERRY ST
Second Line	:	SUITE 410
City	:	DENVER
State	:	CO
Zip	:	80246-1226
Country	:	US
Telephone Number	:	303-377-9500
Fax Number	:	303-377-2712

Provider Business Practice Location Address
First Line	:	425 S CHERRY ST
Second Line	:	SUITE 410
City	:	DENVER
State	:	CO
Zip	:	80246-1226
Country	:	US
Telephone Number	:	303-377-9500
Fax Number	:	303-377-2712

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	DR. GLENN T. FOUST III
Credential	:	M.D.
Telephone Number	:	303-377-9500

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	08/22/2020

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