Provider Demographics
NPI:1437340635
Name:ELIZABETH M BASSOW-SCHEVE MD PC
Entity Type:Organization
Organization Name:ELIZABETH M BASSOW-SCHEVE MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:BASSOW-SCHEVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-425-6012
Mailing Address - Street 1:4045 WADSWORTH BLVD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4642
Mailing Address - Country:US
Mailing Address - Phone:303-425-6012
Mailing Address - Fax:303-467-9211
Practice Address - Street 1:4045 WADSWORTH BLVD
Practice Address - Street 2:SUITE 250
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4642
Practice Address - Country:US
Practice Address - Phone:303-425-6012
Practice Address - Fax:303-467-9211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28175207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO68226853Medicaid
CO11105OtherANTHEM BLUE CROSS/ BLUE S