Provider Demographics
NPI:1538184775
Name:CARDIOVASCULAR ASSOCIATES PC
Entity type:Organization
Organization Name:CARDIOVASCULAR ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:303-595-2600
Mailing Address - Street 1:4101 W CONEJOS PL
Mailing Address - Street 2:SUITE #100
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-1377
Mailing Address - Country:US
Mailing Address - Phone:303-595-2600
Mailing Address - Fax:303-595-2626
Practice Address - Street 1:4101 W CONEJOS PL
Practice Address - Street 2:SUITE #100
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-1377
Practice Address - Country:US
Practice Address - Phone:303-595-2600
Practice Address - Fax:303-595-2626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO207RC0001X, 207RI0011X, 207UN0901X, 2085R0204X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04891081Medicaid
CO04891081Medicaid
CO=========OtherTAX ID NUMBER