Healthcare Provider Details

I. General information

NPI: 1902154776
Provider Name (Legal Business Name): COMPREHENSIVE WOMEN'S CARE OF COLORADO SPRINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 08/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4810 RUSINA RD SUITE B
COLORADO SPRINGS CO
80907-8104
US

IV. Provider business mailing address

4810 RUSINA RD SUITE B
COLORADO SPRINGS CO
80907-8104
US

V. Phone/Fax

Practice location:
  • Phone: 719-358-5377
  • Fax: 719-323-2705
Mailing address:
  • Phone: 719-358-5377
  • Fax: 719-323-2705

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number42372
License Number StateCO

VIII. Authorized Official

Name: STEVEN A FOLEY
Title or Position: PRESIDENT/OWNER
Credential: M.D.
Phone: 719-358-5377