Provider Demographics
NPI:1861726515
Name:ADVANCED UROGYNECOLOGY & PELVIC SURGERY, LLC
Entity type:Organization
Organization Name:ADVANCED UROGYNECOLOGY & PELVIC SURGERY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINELL
Authorized Official - Middle Name:
Authorized Official - Last Name:KEIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-329-5822
Mailing Address - Street 1:4500 E 9TH AVE
Mailing Address - Street 2:SUITE 420
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3900
Mailing Address - Country:US
Mailing Address - Phone:303-329-5822
Mailing Address - Fax:303-329-7934
Practice Address - Street 1:4500 E 9TH AVE
Practice Address - Street 2:SUITE 420
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3900
Practice Address - Country:US
Practice Address - Phone:303-329-5822
Practice Address - Fax:303-329-7934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO35161207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01351618Medicaid
G38380Medicare UPIN