Provider Demographics
NPI:1578181392
Name:COLORADO WEST OTOLARYNGOLOGISTS PC
Entity Type:Organization
Organization Name:COLORADO WEST OTOLARYNGOLOGISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENTINE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-245-2400
Mailing Address - Street 1:100 TESSITORE CT UNIT B
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5689
Mailing Address - Country:US
Mailing Address - Phone:970-787-4710
Mailing Address - Fax:970-615-4007
Practice Address - Street 1:100 TESSITORE CT UNIT B
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5689
Practice Address - Country:US
Practice Address - Phone:970-787-4710
Practice Address - Fax:970-615-4007
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLORADO WEST OTOLARYNGOLOGISTS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-07-08
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty