Provider Demographics
NPI:1467499699
Name:AVISTA WOMENS CARE PC
Entity Type:Organization
Organization Name:AVISTA WOMENS CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:MIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-439-8910
Mailing Address - Street 1:90 HEALTH PARK DR
Mailing Address - Street 2:290
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-9586
Mailing Address - Country:US
Mailing Address - Phone:303-439-8910
Mailing Address - Fax:303-439-9134
Practice Address - Street 1:90 HEALTH PARK DR
Practice Address - Street 2:290
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9586
Practice Address - Country:US
Practice Address - Phone:303-439-8910
Practice Address - Fax:303-439-9134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO38781026Medicaid
COC808302OtherLEGACY NUMBER