MEDICARE: PIKES PEAK NEPHROLOGY 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	207RN0300X	Nephrology Physician

Other Identifiers

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

General Provider Information

NPI Number	:	1386244036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIKES PEAK NEPHROLOGY ASSOCIATES PC

Provider Business Mailing Address
First Line	:	1914 LELARAY ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-2800
Country	:	US
Telephone Number	:	719-632-7641
Fax Number	:	719-632-2925

Provider Business Practice Location Address
First Line	:	2508 AIRPORT RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-3120
Country	:	US
Telephone Number	:	719-380-4842
Fax Number	:

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	JEANINE I PITTMAN
Credential	:
Telephone Number	:	719-632-7641

Provider Enumeration Date	:	10/30/2020
Last Update Date	:	10/30/2020

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