Healthcare Provider Details

I. General information

NPI: 1710659560
Provider Name (Legal Business Name): PIKES PEAK HYPERBARIC MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 03/29/2022
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12229 VOYAGER PKWY STE 120
COLORADO SPRINGS CO
80921-3795
US

IV. Provider business mailing address

162 TRACKER DR STE 120
COLORADO SPRINGS CO
80921-1006
US

V. Phone/Fax

Practice location:
  • Phone: 719-201-8703
  • Fax:
Mailing address:
  • Phone: 719-219-9819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0005X
TaxonomyUndersea and Hyperbaric Medicine (Emergency Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMES AUST
Title or Position: OWNER/PRESIDENT
Credential:
Phone: 719-219-9819