Provider Demographics
NPI:1760785497
Name:TRINIDAD REPRODUCTIVE HEALTHCARE INC
Entity Type:Organization
Organization Name:TRINIDAD REPRODUCTIVE HEALTHCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCI
Authorized Official - Middle Name:L
Authorized Official - Last Name:BOWERS,
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:719-846-6300
Mailing Address - Street 1:134 W MAIN ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:TRINIDAD
Mailing Address - State:CO
Mailing Address - Zip Code:81082-2604
Mailing Address - Country:US
Mailing Address - Phone:719-846-6300
Mailing Address - Fax:719-846-9500
Practice Address - Street 1:134 W MAIN ST
Practice Address - Street 2:SUITE 11
Practice Address - City:TRINIDAD
Practice Address - State:CO
Practice Address - Zip Code:81082-2604
Practice Address - Country:US
Practice Address - Phone:719-846-6300
Practice Address - Fax:719-846-9500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-20
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41164174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO82876827OtherNEW MEXICO MEDICAID
CO13070347Medicaid
CONM009F55OtherNEW MEXICO BLUE CROSS
CO13070347Medicaid