Provider Demographics
NPI:1053479725
Name:A WOMAN'S PLACE
Entity Type:Organization
Organization Name:A WOMAN'S PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL OPERATIONS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THURSTON
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-928-7717
Mailing Address - Street 1:1905 BLAKE AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4288
Mailing Address - Country:US
Mailing Address - Phone:970-928-7717
Mailing Address - Fax:970-928-7727
Practice Address - Street 1:1905 BLAKE AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4288
Practice Address - Country:US
Practice Address - Phone:970-928-7717
Practice Address - Fax:970-928-7727
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VALLEY VIEW HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-12-05
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COAW668216OtherBCBS
CO51627841Medicaid