Healthcare Provider Details

I. General information

NPI: 1467053496
Provider Name (Legal Business Name): OMS ASSOCIATES COLORADO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2020
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 N 10TH ST
CANON CITY CO
81212-3457
US

IV. Provider business mailing address

6160 TUTT BLVD STE 250
COLORADO SPRINGS CO
80923-1500
US

V. Phone/Fax

Practice location:
  • Phone: 719-599-0500
  • Fax: 719-599-0575
Mailing address:
  • Phone: 719-599-0500
  • Fax: 719-599-0575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: SUSAN STEGMAN
Title or Position: CREDENTIALING CO- ORDINATOR
Credential:
Phone: 719-599-0500