Provider Demographics
NPI:1497843916
Name:OBSTETRIX MEDICAL GROUP OF CO
Entity Type:Organization
Organization Name:OBSTETRIX MEDICAL GROUP OF CO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:PAGE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:303-860-9990
Mailing Address - Street 1:1460 UPPER BEAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439-4241
Mailing Address - Country:US
Mailing Address - Phone:303-674-6949
Mailing Address - Fax:
Practice Address - Street 1:1601 E 19TH AVE STE 5050
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1200
Practice Address - Country:US
Practice Address - Phone:303-860-9990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO100795363LP1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP1700XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPerinatalGroup - Single Specialty