Organization
VANGUARD MEDICAL SPECIALISTS LLC
Active
Other names
Vanguard Skin Specialists
Organization subpart
No
Provider details
NPI number
Authorized official
AMBER GUST-ALLEN (REVENUE CYCLE MANAGER)
(719) 465-5643
Entity
Organization
Contact information
Practice address
1100 CARSON AVE, LA JUNTA, CO 81050-2751
(719) 355-1585
Mailing address
PO BOX 5088, DENVER, CO 80217-5088
(719) 355-1585
(719) 623-2983
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
207ND0101X
MOHS-Micrographic Surgery Physician
—
—
207ND0900X
Dermatopathology Physician
—
—
207NP0225X
Pediatric Dermatology Physician
—
—
207NS0135X
Procedural Dermatology Physician
—
—
207YS0123X
Facial Plastic Surgery Physician
—
—
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
—
—
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
—
—
208200000X
Plastic Surgery Physician
—
—
2082S0099X
Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
—
—
Other
Enumeration date
06/24/2021
Last updated
04/01/2024
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