Healthcare Provider Details

I. General information

NPI: 1366406936
Provider Name (Legal Business Name): ELECTROPHYSIOLOGY ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 05/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 PARKSIDE DR SUITE 100
COLORADO SPRINGS CO
80910-3131
US

IV. Provider business mailing address

215 PARKSIDE DR SUITE 100
COLORADO SPRINGS CO
80910-3131
US

V. Phone/Fax

Practice location:
  • Phone: 719-471-9942
  • Fax: 719-471-3051
Mailing address:
  • Phone: 719-471-9942
  • Fax: 719-471-3051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number StateCO

VIII. Authorized Official

Name: MARY ALLISON FORCINITO
Title or Position: ASSISTANT OFFICE MANAGER
Credential:
Phone: 719-471-9942