Provider Demographics
NPI:1821220245
Name:AVISTA WOMENS CARE PC
Entity Type:Organization
Organization Name:AVISTA WOMENS CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING LEAD
Authorized Official - Prefix:MS
Authorized Official - First Name:MIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-439-8910
Mailing Address - Street 1:90 HEALTH PARK DR
Mailing Address - Street 2:SUITE 290
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-9757
Mailing Address - Country:US
Mailing Address - Phone:303-439-8910
Mailing Address - Fax:303-439-9134
Practice Address - Street 1:1225 CIMARRON DR
Practice Address - Street 2:SUITE 101
Practice Address - City:LAFAYETTE
Practice Address - State:CO
Practice Address - Zip Code:80026-3812
Practice Address - Country:US
Practice Address - Phone:303-439-8910
Practice Address - Fax:720-890-2868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06483577Medicaid