Healthcare Provider Details

I. General information

NPI: 1811467517
Provider Name (Legal Business Name): FENIX HEALTH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2018
Last Update Date: 12/28/2022
Certification Date: 12/28/2022
Deactivation Date: 09/14/2021
Reactivation Date: 10/14/2021

III. Provider practice location address

3425 AUSTIN BLUFFS PKWY STE 205
COLORADO SPRINGS CO
80918-5724
US

IV. Provider business mailing address

3425 AUSTIN BLUFFS PKWY STE 205
COLORADO SPRINGS CO
80918-5724
US

V. Phone/Fax

Practice location:
  • Phone: 719-599-5753
  • Fax:
Mailing address:
  • Phone: 719-599-5753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL SPENCER
Title or Position: CHIEF OPERATING OFFICER
Credential: JD
Phone: 719-599-5753