Provider Demographics
NPI:1346581022
Name:COLORADO WOUND CARE, INC.
Entity Type:Organization
Organization Name:COLORADO WOUND CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SPERO
Authorized Official - Middle Name:J
Authorized Official - Last Name:THEODOROU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:914-237-6797
Mailing Address - Street 1:976 MCLEAN AVE
Mailing Address - Street 2:SUITE 387
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10704-4105
Mailing Address - Country:US
Mailing Address - Phone:914-237-6797
Mailing Address - Fax:914-237-6790
Practice Address - Street 1:400 W MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:ASPEN
Practice Address - State:CO
Practice Address - Zip Code:81611-1666
Practice Address - Country:US
Practice Address - Phone:914-237-6797
Practice Address - Fax:208-279-8681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty