Healthcare Provider Details

I. General information

NPI: 1013557362
Provider Name (Legal Business Name): USACS OBSERVATION MEDICINE SERVICES OF COLORADO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 01/23/2026
Certification Date: 01/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N NEVADA AVE
COLORADO SPRINGS CO
80907-6819
US

IV. Provider business mailing address

4535 DRESSLER RD NW
CANTON OH
44718-2545
US

V. Phone/Fax

Practice location:
  • Phone: 844-474-4019
  • Fax: 330-493-8677
Mailing address:
  • Phone: 844-474-4019
  • Fax: 330-493-8677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER CHASTAIN
Title or Position: DIRECTOR OF PROVIDER ENROLLMENT
Credential:
Phone: 330-994-4430