Provider Demographics
NPI:1417162876
Name:PEDIATRIC PARTNERS
Entity Type:Organization
Organization Name:PEDIATRIC PARTNERS
Other - Org Name:VALLEY VIEW HOSPITAL
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BONITA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WASLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-384-6605
Mailing Address - Street 1:1905 BLAKE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4286
Mailing Address - Country:US
Mailing Address - Phone:970-947-9999
Mailing Address - Fax:970-947-9226
Practice Address - Street 1:1905 BLAKE AVE STE 201
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4286
Practice Address - Country:US
Practice Address - Phone:970-947-9999
Practice Address - Fax:970-947-9226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO59106298Medicaid
CO87459213Medicaid
CO55589031Medicaid
CO78107598Medicaid
CO51629313Medicaid
CO90333845Medicaid