Provider Demographics
NPI:1609269497
Name:BERT S FURMANSKY MD PC
Entity Type:Organization
Organization Name:BERT S FURMANSKY MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:FURMANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-831-9200
Mailing Address - Street 1:2875 MANNS RANCH RD
Mailing Address - Street 2:C-1
Mailing Address - City:VAIL
Mailing Address - State:CO
Mailing Address - Zip Code:81657-4645
Mailing Address - Country:US
Mailing Address - Phone:303-831-9200
Mailing Address - Fax:303-831-9200
Practice Address - Street 1:2875 MANNS RANCH RD
Practice Address - Street 2:C-1
Practice Address - City:VAIL
Practice Address - State:CO
Practice Address - Zip Code:81657-4645
Practice Address - Country:US
Practice Address - Phone:303-831-9200
Practice Address - Fax:303-831-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-18
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19824261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO397698Medicare UPIN
COC31991Medicare UPIN