Provider Demographics
NPI:1548661887
Name:SECOND MILE OBSTETRICS AND GYNECOLOGY
Entity type:Organization
Organization Name:SECOND MILE OBSTETRICS AND GYNECOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODWARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-752-3000
Mailing Address - Street 1:10633 WYNSPIRE WAY
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80130-6922
Mailing Address - Country:US
Mailing Address - Phone:303-752-3000
Mailing Address - Fax:303-752-3003
Practice Address - Street 1:1444 S POTOMAC ST STE 100
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4516
Practice Address - Country:US
Practice Address - Phone:303-752-3000
Practice Address - Fax:303-752-3003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-05
Last Update Date:2014-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0028369207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty