Provider Demographics
NPI:1932303997
Name:ROBERT EDWARD WINANS
Entity Type:Organization
Organization Name:ROBERT EDWARD WINANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WINANS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:719-576-4171
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80901-0909
Mailing Address - Country:US
Mailing Address - Phone:719-576-4171
Mailing Address - Fax:
Practice Address - Street 1:17585 CHIPPED ARROW WAY
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-8514
Practice Address - Country:US
Practice Address - Phone:719-596-5665
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO23377174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01233774Medicaid
COC437688Medicare PIN
CO01233774Medicaid