Provider Demographics
NPI:1649710583
Name:DR. MICHAEL WASHINSKY, LLC
Entity type:Organization
Organization Name:DR. MICHAEL WASHINSKY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:970-799-6911
Mailing Address - Street 1:1800 EAST 3RD AVE.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301
Mailing Address - Country:US
Mailing Address - Phone:970-799-6911
Mailing Address - Fax:970-360-5545
Practice Address - Street 1:1800 EAST 3RD AVE.
Practice Address - Street 2:SUITE 102
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301
Practice Address - Country:US
Practice Address - Phone:970-799-6911
Practice Address - Fax:970-360-5545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-25
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00568892084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO47913533Medicaid