Provider Demographics
NPI:1346410578
Name:A WOMAN'S PLACE OF FT. COLLINS,PLLC
Entity Type:Organization
Organization Name:A WOMAN'S PLACE OF FT. COLLINS,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:ROYS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-221-4977
Mailing Address - Street 1:1224 E ELIZABETH ST
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80524-4007
Mailing Address - Country:US
Mailing Address - Phone:970-221-4977
Mailing Address - Fax:
Practice Address - Street 1:1224 E ELIZABETH ST
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80524-4007
Practice Address - Country:US
Practice Address - Phone:970-221-4977
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37437174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO67920845Medicaid
COC495868Medicare PIN