Healthcare Provider Details

I. General information

NPI: 1629618046
Provider Name (Legal Business Name): ERIC WOOLL CSFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2020
Last Update Date: 07/01/2020
Certification Date: 07/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 E WOODMEN RD
COLORADO SPRINGS CO
80923-2601
US

IV. Provider business mailing address

PO BOX 673
MONUMENT CO
80132-0673
US

V. Phone/Fax

Practice location:
  • Phone: 719-457-6200
  • Fax:
Mailing address:
  • Phone: 719-457-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: