Healthcare Provider Details

I. General information

NPI: 1164421582
Provider Name (Legal Business Name): COLORADO CENTER FOR OTOLARYNGOLOGY, PROFESSIONAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 01/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 N UNION BLVD SUITE 310
COLORADO SPRINGS CO
80907-4900
US

IV. Provider business mailing address

3920 N UNION BLVD SUITE 310
COLORADO SPRINGS CO
80907-4900
US

V. Phone/Fax

Practice location:
  • Phone: 719-574-6653
  • Fax: 719-574-2778
Mailing address:
  • Phone: 719-574-6653
  • Fax: 719-574-2778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License NumberBC2020422
License Number StateCO

VIII. Authorized Official

Name: DR. DANIEL K SMITH
Title or Position: PARTNER
Credential: M.D.
Phone: 719-574-6653