Provider Demographics
NPI:1790346997
Name:NWSC CO DR LLC
Entity Type:Organization
Organization Name:NWSC CO DR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ODEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-364-9676
Mailing Address - Street 1:13402 W COAL MINE AVE # 310
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-5407
Mailing Address - Country:US
Mailing Address - Phone:720-758-6760
Mailing Address - Fax:720-758-6761
Practice Address - Street 1:13402 W COAL MINE AVE # 310
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-5407
Practice Address - Country:US
Practice Address - Phone:720-758-6760
Practice Address - Fax:720-758-6761
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-27
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty