Healthcare Provider Details

I. General information

NPI: 1104215235
Provider Name (Legal Business Name): PEDIATRIC SERVICES OF AMERICA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2015
Last Update Date: 12/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 ELKTON DR STE 102
COLORADO SPRINGS CO
80907-8507
US

IV. Provider business mailing address

6 CONCOURSE PKWY STE 1100
ATLANTA GA
30328-6117
US

V. Phone/Fax

Practice location:
  • Phone: 719-548-5052
  • Fax: 719-548-9209
Mailing address:
  • Phone: 770-248-8740
  • Fax: 770-248-8192

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: HARMON STRANGE
Title or Position: PRESIDENT/CEO
Credential:
Phone: 770-441-1580