Healthcare Provider Details

I. General information

NPI: 1326817891
Provider Name (Legal Business Name): GREG W ZINDORF
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2023
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3910 BUNK HOUSE DR
COLORADO SPRINGS CO
80917-2217
US

IV. Provider business mailing address

PO BOX 50005
COLORADO SPRINGS CO
80949-0005
US

V. Phone/Fax

Practice location:
  • Phone: 719-332-0599
  • Fax: 719-260-0101
Mailing address:
  • Phone: 719-332-0599
  • Fax: 719-260-0101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: