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General NPI Number Information
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NPI Number | 1477763712
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Entity Type | Organization
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Legal Business Name | CITY OF COLO. SPGS OCCUPATIONAL HEALTH CLINIC
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 10/23/2014
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Provider Practice Location Address
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Address Line | 30 S NEVADA AVE SUITE 605
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City | COLORADO SPRINGS
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State | CO
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Zip | 80903-1802
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Country | US
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Telephone | 719-385-5965
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Fax | 719-385-5678
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Provider Business Mailing Address
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Address Line | PO BOX 1575 MC 625
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City | COLORADO SPRINGS
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State | CO
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Zip | 80901-1575
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Country | US
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Telephone | 719-385-5965
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Fax | 719-385-5678
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Authorized Official
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Title or Position | OCCUPATIONAL HEALTH SUPERVISOR
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Name | MRS. BERNADETTE ANN RILEY
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Credential | R.N.
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Telephone | 719-385-5673
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QX0100X
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Taxonomy Name | Occupational Medicine Clinic/Center
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License Number |
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License Number State |
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