Healthcare Provider Details

I. General information

NPI: 1396286035
Provider Name (Legal Business Name): PPNA ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2017
Last Update Date: 06/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2002 LELARAY ST SUITE 100
COLORADO SPRINGS CO
80909-2804
US

IV. Provider business mailing address

40 VALLEY STREAM PKWY SUITE 100
MALVERN PA
19355-1407
US

V. Phone/Fax

Practice location:
  • Phone: 719-799-6401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JEANINE PITTMAN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 719-955-2651