Provider Demographics
NPI:1962875351
Name:OWSIANY, JAMES A
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:A
Last Name:OWSIANY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16791 S BRYNMAWR RD
Mailing Address - Street 2:
Mailing Address - City:PINE
Mailing Address - State:CO
Mailing Address - Zip Code:80470-8855
Mailing Address - Country:US
Mailing Address - Phone:303-838-9784
Mailing Address - Fax:303-838-9784
Practice Address - Street 1:16791 S BRYNMAWR RD
Practice Address - Street 2:
Practice Address - City:PINE
Practice Address - State:CO
Practice Address - Zip Code:80470-8855
Practice Address - Country:US
Practice Address - Phone:303-838-9784
Practice Address - Fax:303-838-9784
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-06
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
COUNKNOWNMedicaid