Provider Demographics
NPI:1740310622
Name:FOSS, MEGAN SHANA (PA-C)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:SHANA
Last Name:FOSS
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE
Mailing Address - Street 2:STE 150
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-4443
Mailing Address - Fax:970-490-4175
Practice Address - Street 1:5265 N ACADEMY BLVD
Practice Address - Street 2:SUITE 1800
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-4060
Practice Address - Country:US
Practice Address - Phone:719-599-0444
Practice Address - Fax:719-599-8809
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2016-05-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO1461363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO301329Medicare PIN
COQ07198Medicare UPIN