Provider Demographics
NPI:1730489378
Name:AURORA WOMEN'S CLINIC
Entity Type:Organization
Organization Name:AURORA WOMEN'S CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FORREST
Authorized Official - Middle Name:BRENT
Authorized Official - Last Name:KEELER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-690-8333
Mailing Address - Street 1:14991 E HAMPDEN AVE
Mailing Address - Street 2:SUITE 165
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-3983
Mailing Address - Country:US
Mailing Address - Phone:303-690-8333
Mailing Address - Fax:303-690-8315
Practice Address - Street 1:14991 E HAMPDEN AVE
Practice Address - Street 2:SUITE 165
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-3983
Practice Address - Country:US
Practice Address - Phone:303-690-8333
Practice Address - Fax:303-690-8315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO21740261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04006730Medicaid
COE43616Medicare UPIN