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NPI Code Detail

MEDICARE: JENNIFER LINDEN P.A.

MEDICARE: JENNIFER LINDEN P.A.
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
1363AM0700XMedical Physician Assistant2755CO
2363A00000XPhysician AssistantPA.0002755CO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1274634YKRDOTHERCOMEDICARE NUMBER

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1316189384
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER LINDEN P.A.
Provider Business Mailing Address
First Line : 3205 N ACADEMY BLVD
Second Line : SUITE 130
City : COLORADO SPRINGS
State : CO
Zip : 80917-5101
Country : US
Telephone Number : 719-632-5700
Fax Number : 719-344-7837
Provider Business Practice Location Address
First Line : 722 S WAHSATCH AVE
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80903-4035
Country : US
Telephone Number : 719-632-5700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2009
Last Update Date : 04/04/2017

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