MEDICARE: ACADEMY WOMENS HEALTHCARE ASSOCIATES PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician

General Provider Information

NPI Number	:	1093852725
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACADEMY WOMENS HEALTHCARE ASSOCIATES PC

Provider Business Mailing Address
First Line	:	3204 N ACADEMY BLVD
Second Line	:	SUITE 300
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-5165
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3204 N ACADEMY BLVD
Second Line	:	SUITE 300
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-5165
Country	:	US
Telephone Number	:	719-442-0808
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LAWRENCE O'CONNELL
Credential	:	M.D.
Telephone Number	:	719-442-0808

Provider Enumeration Date	:	01/31/2007
Last Update Date	:	08/22/2020

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