Healthcare Provider Details

I. General information

NPI: 1790377406
Provider Name (Legal Business Name): PEDIATRIC PULMONARY AND SLEEP SPECIALISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 N BOISE AVE
LOVELAND CO
80538-8053
US

IV. Provider business mailing address

9235 N UNION BLVD STE 150334
COLORADO SPRINGS CO
80920-7831
US

V. Phone/Fax

Practice location:
  • Phone: 970-527-1122
  • Fax: 970-527-1123
Mailing address:
  • Phone: 719-638-1122
  • Fax: 719-638-1123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080S0012X
TaxonomyPediatric Sleep Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AMANDA HARRIS
Title or Position: PRACTICE MANAGER
Credential:
Phone: 719-638-1122