Healthcare Provider Details

I. General information

NPI: 1821175100
Provider Name (Legal Business Name): MARK C MEYER MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 CORPORATE DR
COLORADO SPRINGS CO
80919-1941
US

IV. Provider business mailing address

5901 CORPORATE DR
COLORADO SPRINGS CO
80919-1941
US

V. Phone/Fax

Practice location:
  • Phone: 719-598-7562
  • Fax: 719-598-2775
Mailing address:
  • Phone: 719-598-7562
  • Fax: 719-598-2775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MARK C MEYER
Title or Position: MANAGING AGENT
Credential: M.D.
Phone: 719-448-0981