Provider Demographics
NPI:1104014927
Name:CENTER FOR THE ADVANCEMENT OF HEATHCARE EDUCATION AND DELIVERY
Entity Type:Organization
Organization Name:CENTER FOR THE ADVANCEMENT OF HEATHCARE EDUCATION AND DELIVERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:MCMASTER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:719-471-6512
Mailing Address - Street 1:6660 DELMONICO DR
Mailing Address - Street 2:STE D205
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1856
Mailing Address - Country:US
Mailing Address - Phone:719-471-6512
Mailing Address - Fax:719-572-9033
Practice Address - Street 1:325 PARKSIDE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3134
Practice Address - Country:US
Practice Address - Phone:719-471-6512
Practice Address - Fax:719-471-6512
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC811134Medicare PIN