Provider Demographics
NPI:1689788192
Name:WOMENS CLINIC OF THE PLAINS PC
Entity Type:Organization
Organization Name:WOMENS CLINIC OF THE PLAINS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:L
Authorized Official - Last Name:SORIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-542-0930
Mailing Address - Street 1:1000 LINCOLN ST # 230
Mailing Address - Street 2:
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701-3210
Mailing Address - Country:US
Mailing Address - Phone:970-542-0930
Mailing Address - Fax:970-542-0934
Practice Address - Street 1:3464 S WILLOW ST # 555
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-4531
Practice Address - Country:US
Practice Address - Phone:303-755-2900
Practice Address - Fax:303-755-0404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38136207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO94789746Medicaid
CODF8550OtherRAILROAD MEDICARE
CO38136OtherSTATE LICENSE
COC807255Medicare PIN