Provider Demographics
NPI:1447565643
Name:MAURINE C. ONAT MD PC
Entity Type:Organization
Organization Name:MAURINE C. ONAT MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:MCKINLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-733-3660
Mailing Address - Street 1:1501 S GAYLORD ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-2800
Mailing Address - Country:US
Mailing Address - Phone:303-733-3660
Mailing Address - Fax:303-698-9619
Practice Address - Street 1:1501 S GAYLORD ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80210-2800
Practice Address - Country:US
Practice Address - Phone:303-733-3660
Practice Address - Fax:303-968-9619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21802207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01218023Medicaid
COE06420Medicare UPIN
CO01218023Medicaid