Healthcare Provider Details

I. General information

NPI: 1184754731
Provider Name (Legal Business Name): INSTITUTE OF PLASTIC SURGERY, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7606 N UNION BLVD STE A
COLORADO SPRINGS CO
80920-3850
US

IV. Provider business mailing address

7606 N UNION BLVD STE A
COLORADO SPRINGS CO
80920-3850
US

V. Phone/Fax

Practice location:
  • Phone: 719-535-9990
  • Fax: 719-535-9980
Mailing address:
  • Phone: 719-535-9990
  • Fax: 719-535-9980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number42150
License Number StateCO

VIII. Authorized Official

Name: DR. RUPESH JAIN
Title or Position: PRESEDENT
Credential: M.D.
Phone: 719-535-9990