Provider Demographics
NPI:1740462167
Name:LARS A. STANGEBYE, MD
Entity type:Organization
Organization Name:LARS A. STANGEBYE, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LARS
Authorized Official - Middle Name:A
Authorized Official - Last Name:STANGEBYE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-240-4311
Mailing Address - Street 1:816 S 5TH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5765
Mailing Address - Country:US
Mailing Address - Phone:970-240-4311
Mailing Address - Fax:970-240-7976
Practice Address - Street 1:816 S 5TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5765
Practice Address - Country:US
Practice Address - Phone:970-240-4311
Practice Address - Fax:970-240-7976
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO65734751Medicaid
COC331008Medicare PIN
COF44263Medicare UPIN