Healthcare Provider Details

I. General information

NPI: 1831188804
Provider Name (Legal Business Name): COLORADO CARDIAC ALLIANCE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 07/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N NEVADA AVE SUITE 4007
COLORADO SPRINGS CO
80907-6831
US

IV. Provider business mailing address

2222 N NEVADA AVE SUITE 4007
COLORADO SPRINGS CO
80907-6831
US

V. Phone/Fax

Practice location:
  • Phone: 719-776-8500
  • Fax: 719-634-1448
Mailing address:
  • Phone: 719-776-8500
  • Fax: 719-634-1448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number StateCO

VIII. Authorized Official

Name: DR. CHRISTOPHER R COLE
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 719-776-8500