Provider Demographics
NPI:1518926005
Name:SOUTH DENVER OBSTETRICS & GYNECOLOGY PC
Entity Type:Organization
Organization Name:SOUTH DENVER OBSTETRICS & GYNECOLOGY PC
Other - Org Name:SOUTH DENVER OBGYN & MIDWIVES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:R
Authorized Official - Last Name:CHACON-JARAMILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-439-2456
Mailing Address - Street 1:8055 E TUFTS AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80237-2854
Mailing Address - Country:US
Mailing Address - Phone:720-439-2456
Mailing Address - Fax:720-572-5112
Practice Address - Street 1:7780 S BROADWAY STE 280
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2633
Practice Address - Country:US
Practice Address - Phone:303-738-1100
Practice Address - Fax:303-738-1310
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-22
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04014965Medicaid
D9308Medicare ID - Type Unspecified