Healthcare Provider Details

I. General information

NPI: 1477793578
Provider Name (Legal Business Name): IRON HORSE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2009
Last Update Date: 03/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 N TEJON ST SUITE 200
COLORADO SPRINGS CO
80903-1142
US

IV. Provider business mailing address

402 N TEJON ST SUITE 200
COLORADO SPRINGS CO
80903-1142
US

V. Phone/Fax

Practice location:
  • Phone: 719-633-3850
  • Fax: 719-227-0840
Mailing address:
  • Phone: 719-633-3850
  • Fax: 719-227-0840

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. KERRI M BAGNALL
Title or Position: PRESIDENT/PEDIATRICIAN
Credential: M.D.
Phone: 719-633-3850