Provider Demographics
NPI:1306937644
Name:YAMPA VALLEY OB GYN PC
Entity type:Organization
Organization Name:YAMPA VALLEY OB GYN PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOPER
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGER
Authorized Official - Phone:303-586-9390
Mailing Address - Street 1:1600 PINE GROVE ROAD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-4187
Mailing Address - Country:US
Mailing Address - Phone:970-879-8533
Mailing Address - Fax:970-879-8532
Practice Address - Street 1:1600 PINE GROVE ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-4187
Practice Address - Country:US
Practice Address - Phone:970-879-8533
Practice Address - Fax:970-879-8532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04017943Medicaid
CO04017943Medicaid