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General NPI Number Information
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NPI Number | 1356539605
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Entity Type | Organization
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Legal Business Name | COLORADO SPRINGS COLON AND RECTAL SURGERY LLC
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Dates
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Enumeration Date | 10/11/2007
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Last Update Date | 11/01/2010
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Provider Practice Location Address
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Address Line | 1625 MEDICAL CENTER PT SUITE #212
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-8731
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Country | US
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Telephone | 719-475-2566
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Fax | 719-475-2483
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Provider Business Mailing Address
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Address Line | 1625 MEDICAL CENTER PT SUITE #212
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-8731
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Country | US
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Telephone | 719-475-2566
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Fax | 719-475-2483
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARIA HOUSE JAVEED
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Credential | M.D.
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Telephone | 719-475-2566
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208C00000X
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Taxonomy Name | Colon & Rectal Surgery Physician
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License Number | 38764
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License Number State | CO
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