Provider Demographics
NPI:1306831730
Name:DAVID C KELSALL MD PC
Entity Type:Organization
Organization Name:DAVID C KELSALL MD PC
Other - Org Name:ROCKY MOUNTAIN EAR CENTER PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:KELSALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-783-9220
Mailing Address - Street 1:601 E HAMPDEN AVE
Mailing Address - Street 2:SUITE 430
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3781
Mailing Address - Country:US
Mailing Address - Phone:303-783-9220
Mailing Address - Fax:303-806-6292
Practice Address - Street 1:601 E HAMPDEN AVE
Practice Address - Street 2:SUITE 430
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3781
Practice Address - Country:US
Practice Address - Phone:303-783-9220
Practice Address - Fax:303-806-6292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-12
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28228207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & NeurotologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY104545800OtherMEDICAID
P00069393OtherRAILROAD MEDICARE
CO01282284Medicaid
P00069393OtherRAILROAD MEDICARE