Provider Demographics
NPI:1215965686
Name:IRISH, MARGARET ANN (DO)
Entity type:Individual
Prefix:
First Name:MARGARET
Middle Name:ANN
Last Name:IRISH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 58TH AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-4808
Mailing Address - Country:US
Mailing Address - Phone:970-495-0300
Mailing Address - Fax:970-224-9624
Practice Address - Street 1:1175 58TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4808
Practice Address - Country:US
Practice Address - Phone:970-495-0444
Practice Address - Fax:970-488-3106
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2011-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS-936208100000X
CO32909208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000288209OtherHMSA BILLING NUMBER
CO01329093Medicaid
HI636269-01Medicaid
CO01329093Medicaid
HI0000288209OtherHMSA BILLING NUMBER