Provider Demographics
NPI:1336399989
Name:CENTENNIAL WOMENS HEALTH
Entity Type:Organization
Organization Name:CENTENNIAL WOMENS HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:M THERESE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-651-2800
Mailing Address - Street 1:231 E 9TH AVE
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80504-4686
Mailing Address - Country:US
Mailing Address - Phone:303-651-2800
Mailing Address - Fax:
Practice Address - Street 1:231 E 9TH AVE
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80504-4686
Practice Address - Country:US
Practice Address - Phone:303-651-2800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-19
Last Update Date:2010-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29546174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04484011Medicaid
CO01295468Medicaid
CO1336399989Medicaid