Healthcare Provider Details

I. General information

NPI: 1528269099
Provider Name (Legal Business Name): COLORADO SPRINGS PULMONARY CONSULTANTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2312 N NEVADA AVE STE 305
COLORADO SPRINGS CO
80907-5318
US

IV. Provider business mailing address

2312 N NEVADA AVE STE 305
COLORADO SPRINGS CO
80907-5318
US

V. Phone/Fax

Practice location:
  • Phone: 719-471-7064
  • Fax: 719-776-5459
Mailing address:
  • Phone: 719-471-7064
  • Fax: 719-776-5459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number39343
License Number StateCO

VIII. Authorized Official

Name: CRYSTAL MARIE PETERSON
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 719-471-7064