Provider Demographics
NPI:1124023981
Name:COLORADO INFECTIOUS DISEASE ASSOCIATES, LLP
Entity Type:Organization
Organization Name:COLORADO INFECTIOUS DISEASE ASSOCIATES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRODNAX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-777-0781
Mailing Address - Street 1:950 E HARVARD AVE
Mailing Address - Street 2:SUITE 140
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-7009
Mailing Address - Country:US
Mailing Address - Phone:303-777-0781
Mailing Address - Fax:303-777-0786
Practice Address - Street 1:950 E HARVARD AVE
Practice Address - Street 2:SUITE 140
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-7009
Practice Address - Country:US
Practice Address - Phone:303-777-0781
Practice Address - Fax:303-777-0786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-17
Last Update Date:2023-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04768040Medicaid
COC76804Medicare PIN