Healthcare Provider Details

I. General information

NPI: 1235651951
Provider Name (Legal Business Name): BENJAMIN E LINDSKOOG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2017
Last Update Date: 12/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 E BOULDER ST
COLORADO SPRINGS CO
80909-5533
US

IV. Provider business mailing address

777 S MARENGO AVE APT 3
PASADENA CA
91106-4733
US

V. Phone/Fax

Practice location:
  • Phone: 719-364-5000
  • Fax:
Mailing address:
  • Phone: 209-534-8624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number811937
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPN.0993532
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: