MEDICARE: ADVANCED GYNECOLOGY PROF, LLC

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	207VG0400X	Gynecology Physician

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	:	1871576512
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED GYNECOLOGY PROF, LLC

Provider Business Mailing Address
First Line	:	5731 SILVERSTONE TER STE 250
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-3545
Country	:	US
Telephone Number	:	719-633-8773
Fax Number	:	719-633-1905

Provider Business Practice Location Address
First Line	:	5731 SILVERSTONE TER STE 250
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-3545
Country	:	US
Telephone Number	:	719-633-8773
Fax Number	:	719-633-1905

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROY C STRINGFELLOW
Credential	:	MD
Telephone Number	:	719-633-8773

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	10/30/2024

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