GARY ANTHONY SERRAVO (NPI# 1679922777) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1679922777 |
| Entity Type | Individual |
| Full Name | GARY ANTHONY SERRAVO |
| Credential | PA-C |
| Practice Address |
400 W 16th St Pueblo CO 81003-2745 |
| Practice Telephone | 7195844306 |
| Practice Fax Number | 7195844861 |
| Mailing Telephone | 7195844306 |
| Mailing Fax Number | 7195844861 |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2016-07-06 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AM0700X |
Physician Assistant Specialization: Medical |
PA.0004647 | CO | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CO | PHYSICIAN ASSISTANT STATE CERTIFICATION | 0004647 | 01 |
| Street Address |
400 W 16TH ST |
| City | PUEBLO |
| State | CO |
| Zip Code | 81003-2745 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992700694 | James E Caldwell | Anesthesiology | 400 W 16th St, Pueblo, CO 81003-2745 | 2005-06-17 |
| 1174137806 | Pediatrix Medical Group of Colorado, P.C. | Pediatrics | 400 W 16th St, Pueblo, CO 81003-2745 | 2020-09-01 |
| 1992327217 | Kristina Reavis | Nurse Practitioner | 400 W 16th St, Pueblo, CO 81003-2781 | 2020-05-08 |
| 1881214567 | Nathan S Grigg | Student in an Organized Health Care Education/Training Program | 400 W 16th St, Pueblo, CO 81003-2745 | 2020-04-22 |
| 1467083881 | Erik Matthews Wickstrum | Nurse Anesthetist, Certified Registered | 400 W 16th St, Pueblo, CO 81003-2781 | 2020-02-04 |
| 1497385082 | Sean Jastillano | Nurse Anesthetist, Certified Registered | 400 W 16th St, Pueblo, CO 81003-2745 | 2020-01-22 |
| 1417597287 | Zainab Adeyemo | Nurse Anesthetist, Certified Registered | 400 W 16th St, Pueblo, CO 81003-2745 | 2020-01-09 |
| 1265071658 | Victoria Louise Farnsworth | Nurse Anesthetist, Certified Registered | 400 W 16th St, Pueblo, CO 81003-2781 | 2020-01-02 |
| 1205479557 | Brandis Courtney Montez | Nurse Practitioner | 400 W 16th St, Pueblo, CO 81003-2781 | 2019-10-18 |
| 1750923199 | Catholic Health Initiatives Colorado | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 400 W 16th St, Pueblo, CO 81003-2745 | 2019-10-16 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164042016 | Sunil Kumar | Student in an Organized Health Care Education/Training Program | Parkview Adult Medicine Clinic, 311 West 14th Street, Pueblo, CO 81003 | 2020-04-21 |
| 1497382303 | Pueblo Family Dentistry Pllc | Dentist | 701 N Grand Avenue, Suite B, Pueblo, CO 81003 | 2020-03-23 |
| 1023654241 | Elmer A. Villalon, Dmd, LLC | Clinic/Center | 1225 North Main Street, #207, Pueblo, CO 81003 | 2019-11-22 |
| 1518434349 | Mariam Rahim | Internal Medicine | Parkview Adult Medicine Clinic, 311 West 14th Street, Pueblo, CO 81003 | 2018-10-30 |
| 1003308222 | Julia Mcneice | Internal Medicine | Parkview Medial Center, Parkveiw Adult Medicine Clinic, 311 West 14th Street, Pueblo, CO 81003 | 2018-06-04 |
| 1689164857 | Jessica Sels | Internal Medicine | Parkview Medical Center Adult Medicine Clinic, 311 W 14th St, Pueblo, CO 81003 | 2018-05-14 |
| 1700313459 | Allison Vigil | Occupational Therapist | 1600 W. 24th St, Pueblo, CO 81003 | 2017-05-12 |
| 1245682020 | Paul S Bongat | Internal Medicine | 411 W. 14th St., Parkview Adult Medicine Clinic, Pueblo, CO 81003 | 2016-07-06 |
| 1013368596 | Daniel R Long | Internal Medicine | 411 West 14th Street, Pueblo, CO 81003 | 2016-06-27 |
| 1396195665 | Parkview Medical Center | General Acute Care Hospital | 411 W. 14th St, Pueblo, CO 81003 | 2016-06-17 |
| Find all providers in zip 81003 | ||||
| Taxonomy Code | 363AM0700X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Medical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356685747 | Dayna Rae Hochevar | Physician Assistant | 602 Brown Ave, Pueblo, CO 81004 | 2012-11-26 |
| 1164584686 | Michael S Walsh | Physician Assistant | 3116 N. Elizabeth, Pueblo, CO 81008 | 2006-12-14 |
| 1669033973 | Shelby Subry | Physician Assistant | 400 W 16th St, Pueblo, CO 81003-2745 | 2019-06-26 |
| 1003342981 | Vi T Pham | Physician Assistant | 1080 Chinook Ln, Pueblo, CO 81001-1850 | 2017-05-11 |
| 1588057319 | James Richard Anderson | Physician Assistant | 3676 Parker Blvd, Pueblo, CO 81008-2212 | 2015-03-18 |
| 1285040196 | Brittany Stadterman | Physician Assistant | 300 Colorado Ave, Pueblo, CO 81004-2006 | 2014-07-11 |
| 1023342961 | Juan Carlos Herraez Sanchez | Physician Assistant | 1008 Minnequa Ave, Pueblo, CO 81004-3733 | 2009-09-24 |
| 1083869754 | Ginger Rae Todd | Physician Assistant | 300 Colorado Ave, Pueblo, CO 81004-2006 | 2008-11-22 |
| 1093982647 | Nancy Waller | Physician Assistant | 1339 S Pueblo Blvd, Pueblo, CO 81005-1508 | 2008-05-13 |
| 1659542926 | Marc A Williams | Physician Assistant | 1600 N Grand Ave Ste 310, Pueblo, CO 81003-2729 | 2008-03-14 |
| Find all providers in PUEBLO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.