Healthcare Provider Details

I. General information

NPI: 1629820659
Provider Name (Legal Business Name): UNCOMMON HEART PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2024
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1880 OFFICE CLUB PT STE 124
COLORADO SPRINGS CO
80920-5012
US

IV. Provider business mailing address

1880 OFFICE CLUB PT STE 124
COLORADO SPRINGS CO
80920-5012
US

V. Phone/Fax

Practice location:
  • Phone: 719-357-6580
  • Fax:
Mailing address:
  • Phone: 719-357-6507
  • Fax: 719-779-1361

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: NICHOLAS ROBERT FRY
Title or Position: CEO
Credential: LCSW
Phone: 719-357-6580