Provider Demographics
NPI:1841420932
Name:COLLIN F. SHARP M.D. P.C.
Entity Type:Organization
Organization Name:COLLIN F. SHARP M.D. P.C.
Other - Org Name:BLUE SKY SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:COLLIN
Authorized Official - Middle Name:F
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-765-8965
Mailing Address - Street 1:203 S NEVADA AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-4233
Mailing Address - Country:US
Mailing Address - Phone:970-765-8965
Mailing Address - Fax:970-765-8955
Practice Address - Street 1:203 S NEVADA AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-4233
Practice Address - Country:US
Practice Address - Phone:970-249-7751
Practice Address - Fax:970-249-5029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-23
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO47466208600000X
261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1841420932OtherNPI TYPE II (ORGANIZATION)
COCO41026OtherMEDICARE INDIVVIDUAL PTAN
COCOB4729OtherMEDICARE GROUP PTAN