Healthcare Provider Details

I. General information

NPI: 1184731721
Provider Name (Legal Business Name): COLORADO SPRINGS ALLERGY & ASTHMA CLINIC, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 AUSTIN BLUFFS PKWY SUITE 205
COLORADO SPRINGS CO
80918-5701
US

IV. Provider business mailing address

3425 AUSTIN BLUFFS PKWY SUITE 205
COLORADO SPRINGS CO
80918-5701
US

V. Phone/Fax

Practice location:
  • Phone: 719-592-1365
  • Fax: 719-592-1370
Mailing address:
  • Phone: 719-592-1365
  • Fax: 719-592-1370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: MARTHA HARRELL
Title or Position: OFFICE MANAGER
Credential:
Phone: 719-592-1582