Healthcare Provider Details

I. General information

NPI: 1073294054
Provider Name (Legal Business Name): JOSHUA LEE RYKEN SA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 E WOODMEN RD
COLORADO SPRINGS CO
80923-2601
US

IV. Provider business mailing address

8149 LOOKOUT CT
COLORADO SPRINGS CO
80925-1454
US

V. Phone/Fax

Practice location:
  • Phone: 719-776-5000
  • Fax:
Mailing address:
  • Phone: 816-799-5702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number23-334
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: