Provider Demographics
NPI:1891725594
Name:STAN WORLEY MD PC
Entity Type:Organization
Organization Name:STAN WORLEY MD PC
Other - Org Name:COLORADO INTERNAL MEDICINE AND GERIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WORLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-952-1093
Mailing Address - Street 1:PO BOX 3698
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80161-3698
Mailing Address - Country:US
Mailing Address - Phone:303-952-1093
Mailing Address - Fax:
Practice Address - Street 1:4231 W 16TH AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-1335
Practice Address - Country:US
Practice Address - Phone:303-952-1093
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO34502068Medicaid
C325508Medicare PIN