Healthcare Provider Details

I. General information

NPI: 1558363705
Provider Name (Legal Business Name): PIKES PEAK CARDIOLOGY A PROFESSIONAL LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E BOULDER ST SUITE 700
COLORADO SPRINGS CO
80909-5533
US

IV. Provider business mailing address

PO BOX 9809
COLORADO SPRINGS CO
80932-0809
US

V. Phone/Fax

Practice location:
  • Phone: 719-635-7172
  • Fax:
Mailing address:
  • Phone: 719-635-7172
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM MANTIA III
Title or Position: CEO
Credential:
Phone: 719-635-7172