Basic Information
Provider Information
NPI: 1447830971
EntityType: 2
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OrganizationName: OBSTETRIX MEDICAL GROUP OF COLORADO, PC
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Mailing Information
Address1: 4722 N 24TH ST STE 100
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City: PHOENIX
State: AZ
PostalCode: 850164838
CountryCode: US
TelephoneNumber: 8777374546
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Practice Location
Address1: 1801 16TH ST STE C1412
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City: GREELEY
State: CO
PostalCode: 806315154
CountryCode: US
TelephoneNumber: 9708106070
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Other Information
ProviderEnumerationDate: 04/09/2021
LastUpdateDate: 04/09/2021
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AuthorizedOfficialLastName: PORRECO
AuthorizedOfficialFirstName: RICHARD
AuthorizedOfficialMiddleName: P
AuthorizedOfficialTitleorPosition: PRESIDENT
AuthorizedOfficialTelephone: 9543840175
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IsOrganizationSubpart: N
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AuthorizedOfficialCredential: MD
NPICertificationDate: 04/09/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LW0102X  N193200000X MULTI-SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
363LX0001X  N193200000X MULTI-SPECIALTY GROUPPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
207VM0101X  Y193200000X MULTI-SPECIALTY GROUPAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine

No ID Information.


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