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General NPI Number Information
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NPI Number | 1306095914
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Entity Type | Organization
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Legal Business Name | SOUTHERN COLORADO MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 09/18/2008
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Last Update Date | 09/18/2008
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Provider Practice Location Address
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Address Line | 1727 N WEBER ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-7503
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Country | US
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Telephone | 719-955-2495
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Fax | 719-955-2499
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Provider Business Mailing Address
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Address Line | 1727 N WEBER ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-7503
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Country | US
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Telephone | 719-955-2495
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Fax | 719-955-2499
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. BILL CARTER
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Credential |
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Telephone | 719-955-2495
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 207Q00000X
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License Number State | CO
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