Healthcare Provider Details

I. General information

NPI: 1386563179
Provider Name (Legal Business Name): PROHEALTH MEDICAL MANAGMENT GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6530 S ACADEMY BLVD
COLORADO SPRINGS CO
80906-8635
US

IV. Provider business mailing address

2226 HILLSIDE RD
PUEBLO CO
81006-1831
US

V. Phone/Fax

Practice location:
  • Phone: 719-251-0241
  • Fax:
Mailing address:
  • Phone: 719-251-0241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREA MEDINA
Title or Position: OWNER
Credential:
Phone: 719-251-0241