MEDICARE: WOMENS CLINIC OF THE PLAINS 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	207V00000X	Obstetrics & Gynecology Physician	38136	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DF8550	OTHER	CO	RAILROAD MEDICARE

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
3	38136	OTHER	CO	STATE LICENSE

General Provider Information

NPI Number	:	1689788192
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOMENS CLINIC OF THE PLAINS PC

Provider Business Mailing Address
First Line	:	1000 LINCOLN ST # 230
Second Line	:
City	:	FORT MORGAN
State	:	CO
Zip	:	80701-3210
Country	:	US
Telephone Number	:	970-542-0930
Fax Number	:	970-542-0934

Provider Business Practice Location Address
First Line	:	3464 S WILLOW ST # 555
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-4531
Country	:	US
Telephone Number	:	303-755-2900
Fax Number	:	303-755-0404

Authorized Official
Title or Position	:	OWNER
Name	:	MICHELLE L SORIANO
Credential	:	MD
Telephone Number	:	970-542-0930

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	11/02/2007

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