Healthcare Provider Details

I. General information

NPI: 1003710336
Provider Name (Legal Business Name): TEREFE MOGES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 S TEJON ST STE 1100
COLORADO SPRINGS CO
80903-2253
US

IV. Provider business mailing address

102 S TEJON ST STE 1100
COLORADO SPRINGS CO
80903-2253
US

V. Phone/Fax

Practice location:
  • Phone: 720-427-6409
  • Fax:
Mailing address:
  • Phone: 720-427-6409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: