Provider Demographics
NPI:1871576512
Name:ADVANCED GYNECOLOGY PROF, LLC
Entity type:Organization
Organization Name:ADVANCED GYNECOLOGY PROF, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:C
Authorized Official - Last Name:STRINGFELLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-633-8773
Mailing Address - Street 1:5731 SILVERSTONE TER STE 250
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-3545
Mailing Address - Country:US
Mailing Address - Phone:719-633-8773
Mailing Address - Fax:719-633-1905
Practice Address - Street 1:5731 SILVERSTONE TER STE 250
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-3545
Practice Address - Country:US
Practice Address - Phone:719-633-8773
Practice Address - Fax:719-633-1905
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-28
Last Update Date:2024-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO41885244Medicaid
CO41885244Medicaid