Provider Demographics
NPI:1174580914
Name:GEORGE BIRKS MD PLLC
Entity type:Organization
Organization Name:GEORGE BIRKS MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:F
Authorized Official - Last Name:BIRKS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:719-565-1900
Mailing Address - Street 1:PO BOX 8537
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-8537
Mailing Address - Country:US
Mailing Address - Phone:719-566-1869
Mailing Address - Fax:719-565-1901
Practice Address - Street 1:1930 E ORMAN AVE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3553
Practice Address - Country:US
Practice Address - Phone:719-565-1900
Practice Address - Fax:719-565-1901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-26
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35413207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO82685029Medicaid
CO110246700OtherRAILROAD MEDICARE
CODG5436OtherRAILROAD MEDICARE
COG21903Medicare UPIN
CO802206Medicare ID - Type Unspecified
CO82685029Medicaid