Provider Demographics
NPI:1861593337
Name:SOUTH DENVER INFECTIOUS DISEASE SPECIALISTS PC
Entity type:Organization
Organization Name:SOUTH DENVER INFECTIOUS DISEASE SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:BLACKWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-788-5900
Mailing Address - Street 1:601 E HAMPDEN AVE
Mailing Address - Street 2:SUITE # 340
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-3781
Mailing Address - Country:US
Mailing Address - Phone:303-788-5900
Mailing Address - Fax:303-788-5922
Practice Address - Street 1:601 E HAMPDEN AVE
Practice Address - Street 2:SUITE # 340
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-3781
Practice Address - Country:US
Practice Address - Phone:303-788-5900
Practice Address - Fax:303-788-5922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCE8711OtherRR MEDICARE PIN
CO04011003Medicaid
CO04011003Medicaid