Provider Demographics
NPI:1508058710
Name:JOHN F WOLZ MD PROF LLC
Entity Type:Organization
Organization Name:JOHN F WOLZ MD PROF LLC
Other - Org Name:COLORADO EMERGENCY SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-867-4916
Mailing Address - Street 1:PO BOX 799
Mailing Address - Street 2:
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701-0799
Mailing Address - Country:US
Mailing Address - Phone:970-867-4916
Mailing Address - Fax:970-867-8659
Practice Address - Street 1:625 W PLATTE AVE
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-2669
Practice Address - Country:US
Practice Address - Phone:970-867-4916
Practice Address - Fax:970-867-8659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-11
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAW4243462086S0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical CareGroup - Single Specialty