Wheat Ridge General and Vascular Surgical Associates PC
Organization Active NPI Medical Specialty Clinic/Center · Wheat Ridge, CO
NPI 1467526186 · NPPES record last updated Feb 17, 2010
Key facts
- NPI
- 1467526186
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Medical Specialty Clinic/Center 261QM2500X
- License
- 29993 (CO)
- Legal business name
- WHEAT RIDGE GENERAL AND VASCULAR SURGICAL ASSOCIATES PC
- Practice address
- 7805 W 38TH Ave
Wheat Ridge, CO 80033-6109 - Phone
- (303) 431-2900
- Fax
- (303) 431-2999
- NPI assigned
- Nov 17, 2006
- Organization subpart
- No
Authorized official
- Name
- Lisa A Defeyter
- Title
- Secretary
- Phone
- (303) 431-2900
Practitioners 1
-
Brian A Ridge, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040602001127 | CO | Part B Supplier - Clinic/Group Practice | 4688656838 |
Receives reassigned benefits from 1 practitioner Practice locations: Wheat Ridge, CO |
National Provider Directory
Locations
7805 W 38th Ave
Wheat Ridge, CO 80033
Phone (303) 431-2900
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Specialty Clinic/Center | 261QM2500X | 29993 | CO | Yes |
Addresses
Primary practice location
7805 W 38TH Ave
Wheat Ridge, CO 80033-6109
Mailing address
7805 W 38TH Ave
Wheat Ridge, CO 80033-6109
Phone (303) 431-2900
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04020210 | Medicaid | CO |
Other providers in Wheat Ridge, CO
- Wheat Ridge Dentists, LLP
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- Wheat Ridge Family Dental
- Wheat Ridge Family Dentistry
- Wheat Ridge Foot & Ankle Center, PC
- Wheat Ridge Healthcare LLC
- Wheat Ridge Healthcare LLC
- Wheat Ridge Internal Medicine PC
- Wheat Ridge Oral Surgery
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All providers in Wheat Ridge, CO · Medical Specialty Clinic/Center in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 17, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.