Provider Demographics
NPI:1649927740
Name:WESTERN INFECTIOUS DISEASE INFUSION CENTER, INC
Entity type:Organization
Organization Name:WESTERN INFECTIOUS DISEASE INFUSION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-425-9245
Mailing Address - Street 1:3885 UPHAM ST STE 200
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4800
Mailing Address - Country:US
Mailing Address - Phone:303-425-9245
Mailing Address - Fax:720-974-7431
Practice Address - Street 1:1551 PROFESSIONAL LN UNIT 280
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6965
Practice Address - Country:US
Practice Address - Phone:303-425-9245
Practice Address - Fax:720-600-5140
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WESTERN INFECTIOUS DISEASE INFUSION CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-08
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty