Healthcare Provider Details

I. General information

NPI: 1023214905
Provider Name (Legal Business Name): MELISSA CARY-JACOBS SCHMOEKEL D.O
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA CARY JACOBS D.O

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E BOULDER ST STE 2508
COLORADO SPRINGS CO
80909
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE STE 150
LOVELAND CO
80538-9071
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-6999
  • Fax: 719-365-2837
Mailing address:
  • Phone: 970-624-4034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDR.0061988
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number5101017441
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: