Healthcare Provider Details

I. General information

NPI: 1083064711
Provider Name (Legal Business Name): COLORADO PERMANENTE MEDICAL GROUP, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2016
Last Update Date: 06/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 S PARKSIDE DR
COLORADO SPRINGS CO
80910-3131
US

IV. Provider business mailing address

10350 E DAKOTA AVE
DENVER CO
80247-1314
US

V. Phone/Fax

Practice location:
  • Phone: 303-338-3800
  • Fax:
Mailing address:
  • Phone: 303-344-7212
  • Fax: 303-344-7646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number StateCO

VIII. Authorized Official

Name: ROBERT HINSKTON
Title or Position: CPMG MEDICARECOMPLIANCE COORDINATOR
Credential:
Phone: 303-344-7212