Provider Demographics
NPI:1639211451
Name:STEPHANIE L. PENROSE, M.D., P.C.
Entity Type:Organization
Organization Name:STEPHANIE L. PENROSE, M.D., P.C.
Other - Org Name:GENERATIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:C
Authorized Official - Last Name:BAHM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-797-7227
Mailing Address - Street 1:11175 E MISSISSIPPI AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-3137
Mailing Address - Country:US
Mailing Address - Phone:303-797-7227
Mailing Address - Fax:303-797-8448
Practice Address - Street 1:11175 E MISSISSIPPI AVE STE 210
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-3137
Practice Address - Country:US
Practice Address - Phone:303-797-7227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO00535851Medicaid
CO14156814Medicaid