Healthcare Provider Details

I. General information

NPI: 1174746853
Provider Name (Legal Business Name): COLORADO SPRINGS EAR ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 05/20/2021
Certification Date: 02/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2950 PROFESSIONAL PL STE 100
COLORADO SPRINGS CO
80904-8106
US

IV. Provider business mailing address

2950 PROFESSIONAL PL STE 100
COLORADO SPRINGS CO
80904-8106
US

V. Phone/Fax

Practice location:
  • Phone: 719-667-1327
  • Fax: 719-667-1328
Mailing address:
  • Phone: 719-667-1327
  • Fax: 719-667-1328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332S00000X
TaxonomyHearing Aid Equipment
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number39522
License Number StateCO

VIII. Authorized Official

Name: DR. JOSEPH L HEGARTY
Title or Position: MEMBER MANAGER
Credential: MD
Phone: 719-667-1327