Provider Demographics
NPI:1376766303
Name:ASELA C RUSSELL MD PC
Entity Type:Organization
Organization Name:ASELA C RUSSELL MD PC
Other - Org Name:CENTER FOR WOMEN'S HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ASELA
Authorized Official - Middle Name:C
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-755-0120
Mailing Address - Street 1:8000 E PRENTICE AVE STE D10
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2728
Mailing Address - Country:US
Mailing Address - Phone:303-755-0120
Mailing Address - Fax:833-989-2368
Practice Address - Street 1:8000 E PRENTICE AVE STE D10
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2728
Practice Address - Country:US
Practice Address - Phone:303-755-0120
Practice Address - Fax:833-989-2368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO28049174400000X
207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO29627206Medicaid
COC802592Medicare PIN