Provider Demographics
NPI:1689672610
Name:DENVER-EVERGREEN OB-GYN GRP., PC
Entity Type:Organization
Organization Name:DENVER-EVERGREEN OB-GYN GRP., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:T
Authorized Official - Last Name:FOUST
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:303-377-9500
Mailing Address - Street 1:425 S CHERRY ST
Mailing Address - Street 2:SUITE 410
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-1226
Mailing Address - Country:US
Mailing Address - Phone:303-377-9500
Mailing Address - Fax:303-377-2712
Practice Address - Street 1:425 S CHERRY ST
Practice Address - Street 2:SUITE 410
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80246-1226
Practice Address - Country:US
Practice Address - Phone:303-377-9500
Practice Address - Fax:303-377-2712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04006607Medicaid
COCF3408Medicare ID - Type UnspecifiedMEDICARE