MEDICARE: GERALD A. HAMSTRA, D.O., P.C.

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	207Q00000X	Family Medicine Physician	17495	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	014042929	OTHER		RAILROAD MEDICARE

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	:	1821262841
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERALD A. HAMSTRA, D.O., P.C.

Provider Business Mailing Address
First Line	:	PO BOX 25819
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80936-5819
Country	:	US
Telephone Number	:	719-574-7849
Fax Number	:	719-574-3776

Provider Business Practice Location Address
First Line	:	4775 JAMESTOWN DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-2725
Country	:	US
Telephone Number	:	719-574-7849
Fax Number	:	719-574-3776

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GERALD A HAMSTRA
Credential	:	D.O.
Telephone Number	:	719-574-7849

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	09/19/2011

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