Healthcare Provider Details

I. General information

NPI: 1326253436
Provider Name (Legal Business Name): ALLIANCE FAMILY PRACTICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 01/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 GRAND CORDERA PKWY SUITE 100
COLORADO SPRINGS CO
80924-7003
US

IV. Provider business mailing address

9320 GRAND CORDERA PKWY SUITE 100
COLORADO SPRINGS CO
80924-7003
US

V. Phone/Fax

Practice location:
  • Phone: 719-282-6337
  • Fax: 719-282-0532
Mailing address:
  • Phone: 719-282-6337
  • Fax: 719-282-0532

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. MARK PHILP CARROLL II
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 719-282-6337