Healthcare Provider Details

I. General information

NPI: 1881630309
Provider Name (Legal Business Name): PRINTERS PARK OBGYN, A PROFESSIONAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 09/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 S UNION BLVD SUITE 220
COLORADO SPRINGS CO
80910-3147
US

IV. Provider business mailing address

175 S UNION BLVD SUITE 220
COLORADO SPRINGS CO
80910-3147
US

V. Phone/Fax

Practice location:
  • Phone: 719-634-1532
  • Fax: 719-634-1715
Mailing address:
  • Phone: 719-634-1532
  • Fax: 719-634-1715

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateCO

VIII. Authorized Official

Name: MS. SUSAN M OGDEN
Title or Position: CERTIFIED MEDICAL MANAGER
Credential: CMM
Phone: 719-634-1532