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General NPI Number Information
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NPI Number | 1407760614
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Entity Type | Organization
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Legal Business Name | PONYA DIAGNOSTICS OF COLORADO LLC
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Dates
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Enumeration Date | 10/02/2026
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Last Update Date | 10/02/2026
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Provider Practice Location Address
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Address Line | 4725 TOWN CENTER DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80916-4732
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Country | US
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Telephone | 229-442-7210
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Fax |
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Provider Business Mailing Address
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Address Line | 13 CORPORATE BLVD NE STE 250
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City | BROOKHAVEN
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State | GA
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Zip | 30329-1901
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Country | US
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Telephone | 229-442-7210
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Fax | 404-521-4323
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Authorized Official
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Title or Position | DIR OF LABORATORY ADMIN SERVICES
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Name | MS. SHAMYA CHERIESE KOEN
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Credential |
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Telephone | 229-442-7210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State | NULL
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