Healthcare Provider Details

I. General information

NPI: 1225624513
Provider Name (Legal Business Name): IRON HORSE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 BRIARGATE PKWY STE 205
COLORADO SPRINGS CO
80920-3484
US

IV. Provider business mailing address

402 N TEJON ST STE 200
COLORADO SPRINGS CO
80903-1155
US

V. Phone/Fax

Practice location:
  • Phone: 719-633-3850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRIS WOODY
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 719-633-3850