Healthcare Provider Details

I. General information

NPI: 1043295355
Provider Name (Legal Business Name): EAR NOSE AND THROAT OF COLORADO SPRINGS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2403 N UNION BLVD SUITE 103
COLORADO SPRINGS CO
80909-1185
US

IV. Provider business mailing address

2403 N UNION BLVD SUITE 103
COLORADO SPRINGS CO
80909-1185
US

V. Phone/Fax

Practice location:
  • Phone: 712-963-2502
  • Fax:
Mailing address:
  • Phone: 712-963-2502
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number16439
License Number StateCO

VIII. Authorized Official

Name: THOMAS DALSASO SR.
Title or Position: PRESIDENT
Credential:
Phone: 719-632-5020