Basic Information
| Provider Information | |||||||||
| NPI: | 1003005950 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WORTH | ||||||||
| FirstName: | HEIDI | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | DICKSTEIN | ||||||||
| OtherFirstName: | HEIDI | ||||||||
| OtherMiddleName: | W. | ||||||||
| OtherNamePrefix: | MRS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1197 BLUE RIDGE RD | ||||||||
| Address2: | PO BOX 2044 | ||||||||
| City: | SILVERTHORNE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804988926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702620600 | ||||||||
| FaxNumber: | 9702620700 | ||||||||
| Practice Location | |||||||||
| Address1: | 1197 BLUE RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | SILVERTHORNE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804988926 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702620600 | ||||||||
| FaxNumber: | 9702620700 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/16/2007 | ||||||||
| LastUpdateDate: | 10/16/2007 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 46106 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.