Provider Demographics
NPI:1518612886
Name:CHEYENNE MOUNTAIN GYNECOLOGY LLC
Entity Type:Organization
Organization Name:CHEYENNE MOUNTAIN GYNECOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMPLOYEE
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:FINK
Authorized Official - Suffix:
Authorized Official - Credentials:NP, CNM
Authorized Official - Phone:786-493-6158
Mailing Address - Street 1:2874 STRATTON WOODS VW
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-6921
Mailing Address - Country:US
Mailing Address - Phone:786-493-6158
Mailing Address - Fax:
Practice Address - Street 1:2874 STRATTON WOODS VW
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-6921
Practice Address - Country:US
Practice Address - Phone:786-493-6158
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty