Healthcare Provider Details

I. General information

NPI: 1376324293
Provider Name (Legal Business Name): CS CARDIOLOGY NEWCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2023
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 MEDICAL CENTER PT STE 105
COLORADO SPRINGS CO
80907-8733
US

IV. Provider business mailing address

PO BOX 661266
DALLAS TX
75266-1266
US

V. Phone/Fax

Practice location:
  • Phone: 719-960-0363
  • Fax:
Mailing address:
  • Phone: 719-445-7544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIN PETRIE
Title or Position: VP OF RCM
Credential:
Phone: 708-498-4493