Provider Demographics
NPI:1528220258
Name:PETER M. BIANCO DO LLC
Entity Type:Organization
Organization Name:PETER M. BIANCO DO LLC
Other - Org Name:COLORADO SPRINGS GYNECOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:M
Authorized Official - Last Name:BIANCO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:719-598-0500
Mailing Address - Street 1:5333 N UNION BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-2051
Mailing Address - Country:US
Mailing Address - Phone:719-598-0500
Mailing Address - Fax:719-268-6834
Practice Address - Street 1:5333 N UNION BLVD
Practice Address - Street 2:STE 200
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-2051
Practice Address - Country:US
Practice Address - Phone:719-598-0500
Practice Address - Fax:719-268-6834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-25
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27337261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center