Provider Demographics
NPI:1649090085
Name:PEDIATRIC & ADOLESCENT GYNECOLOGY OF THE ROCKY MOUNTAINS
Entity type:Organization
Organization Name:PEDIATRIC & ADOLESCENT GYNECOLOGY OF THE ROCKY MOUNTAINS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-587-7380
Mailing Address - Street 1:3073 S BOSTON CT
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-6406
Mailing Address - Country:US
Mailing Address - Phone:214-587-7380
Mailing Address - Fax:
Practice Address - Street 1:7180 E ORCHARD RD STE 101
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-1725
Practice Address - Country:US
Practice Address - Phone:303-861-4480
Practice Address - Fax:303-861-4490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty