Provider Demographics
NPI:1376753723
Name:COLORADO GYN CONSULTANTS, P.C.
Entity Type:Organization
Organization Name:COLORADO GYN CONSULTANTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-353-1335
Mailing Address - Street 1:1800 15TH ST
Mailing Address - Street 2:STE 220
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-4500
Mailing Address - Country:US
Mailing Address - Phone:970-353-1335
Mailing Address - Fax:970-353-7376
Practice Address - Street 1:1800 15TH ST
Practice Address - Street 2:STE 220
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-4500
Practice Address - Country:US
Practice Address - Phone:970-353-1335
Practice Address - Fax:970-353-7376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01256049Medicaid
COC371318Medicare PIN
COE30167Medicare UPIN