Healthcare Provider Details

I. General information

NPI: 1548658354
Provider Name (Legal Business Name): PIKES PEAK ORTHOPAEDIC SURGERY AND SPORTS MEDICINE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2014
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2925 PROFESSIONAL PL STE 110
COLORADO SPRINGS CO
80904-8126
US

IV. Provider business mailing address

2925 PROFESSIONAL PL STE 110
COLORADO SPRINGS CO
80904-8134
US

V. Phone/Fax

Practice location:
  • Phone: 719-445-0344
  • Fax: 719-445-0357
Mailing address:
  • Phone: 719-445-0344
  • Fax: 719-445-0357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number40753
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL B RAHILL
Title or Position: OWNER
Credential: MD
Phone: 719-445-0344