Basic Information
| Provider Information | |||||||||
| NPI: | 1306831250 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLORADO WEST OTOLARYNGOLOGISTS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2643 PATTERSON RD | ||||||||
| Address2: | SUITE 503 | ||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 815061953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702452400 | ||||||||
| FaxNumber: | 9702429092 | ||||||||
| Practice Location | |||||||||
| Address1: | 2643 PATTERSON RD | ||||||||
| Address2: | SUITE 503 | ||||||||
| City: | GRAND JUNCTION | ||||||||
| State: | CO | ||||||||
| PostalCode: | 815061953 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9702452400 | ||||||||
| FaxNumber: | 9702429092 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2005 | ||||||||
| LastUpdateDate: | 01/13/2017 | ||||||||
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| AuthorizedOfficialLastName: | HOWERY | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9702452400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207YX0905X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology | Otolaryngology/Facial Plastic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 04007308 | 05 | CO | MEDICAID |