=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013172162
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTHSIDE ASSOCIATES, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/28/2008
-----------------------------------------------------
Last Update Date | 07/28/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8890 N UNION BLVD SUITE 200
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80920-7799
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-475-2566
-----------------------------------------------------
Fax | 719-475-2483
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8890 N UNION BLVD SUITE 200
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80920-7799
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-475-2566
-----------------------------------------------------
Fax | 719-475-2483
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD
-----------------------------------------------------
Name | MARIA JAVEED
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 719-475-2566
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------