Provider Demographics
NPI:1134643604
Name:CLINICAL COLLEAGUES INC
Entity Type:Organization
Organization Name:CLINICAL COLLEAGUES INC
Other - Org Name:CLINICAL COLLEAGUES INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:GERDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-494-3964
Mailing Address - Street 1:PO BOX 824246
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19182-4246
Mailing Address - Country:US
Mailing Address - Phone:954-570-0337
Mailing Address - Fax:
Practice Address - Street 1:2100 W SUNSET DR
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:WY
Practice Address - Zip Code:82501-2274
Practice Address - Country:US
Practice Address - Phone:800-494-3964
Practice Address - Fax:954-570-0317
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLINICAL COLLEAGUES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-27
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty