Provider Demographics
NPI:1518930882
Name:ADVANCED OTOLARYNGOLOGY, P.C.
Entity Type:Organization
Organization Name:ADVANCED OTOLARYNGOLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EFFIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:BURKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-493-5334
Mailing Address - Street 1:2001 S SHIELDS ST STE E101
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80526-1872
Mailing Address - Country:US
Mailing Address - Phone:970-493-5334
Mailing Address - Fax:970-472-0638
Practice Address - Street 1:2001 S SHIELDS ST STE E101
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-1872
Practice Address - Country:US
Practice Address - Phone:970-493-5334
Practice Address - Fax:970-472-0638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-08
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CODA0290OtherRAILROAD GROUP ID
CO04011946Medicaid
CO498868Medicare ID - Type Unspecified