Provider Demographics
NPI:1417332453
Name:COLORADO ALLERGY AND ASTHMA CENTERS
Entity Type:Organization
Organization Name:COLORADO ALLERGY AND ASTHMA CENTERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:WERTZ
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:303-632-3694
Mailing Address - Street 1:14000 E ARAPAHOE RD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-4043
Mailing Address - Country:US
Mailing Address - Phone:303-632-3694
Mailing Address - Fax:303-632-3692
Practice Address - Street 1:14000 E ARAPAHOE RD
Practice Address - Street 2:SUITE 240
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-4043
Practice Address - Country:US
Practice Address - Phone:303-632-3694
Practice Address - Fax:303-632-3692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-20
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1455363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty