Provider Demographics
NPI:1093065245
Name:PENELOPE H THRON-WEBER
Entity Type:Organization
Organization Name:PENELOPE H THRON-WEBER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PENELOPE
Authorized Official - Middle Name:H
Authorized Official - Last Name:THRON-WEBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-985-8773
Mailing Address - Street 1:PO BOX 643
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80034-0643
Mailing Address - Country:US
Mailing Address - Phone:303-985-8773
Mailing Address - Fax:303-985-0827
Practice Address - Street 1:1370 S WADSWORTH BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-5439
Practice Address - Country:US
Practice Address - Phone:303-985-8773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-14
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26213207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0126213Medicaid