=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285579904
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNASHAMED OUTREACH GROUP, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2026
-----------------------------------------------------
Last Update Date | 04/20/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1880 OFFICE CLUB PT STE 263
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80920-5019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-636-2059
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1880 OFFICE CLUB PT STE 263
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80920-5019
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 214-636-2059
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER
-----------------------------------------------------
Name | WILLIAM RYAN TALBOT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 214-636-2059
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 172V00000X
-----------------------------------------------------
Taxonomy Name | Community Health Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------