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General NPI Number Information
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NPI Number | 1528269099
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Entity Type | Organization
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Legal Business Name | COLORADO SPRINGS PULMONARY CONSULTANTS PC
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 10/16/2024
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Provider Practice Location Address
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Address Line | 2312 N NEVADA AVE STE 305
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-5318
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Country | US
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Telephone | 719-471-7064
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Fax | 719-776-5459
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Provider Business Mailing Address
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Address Line | 2312 N NEVADA AVE STE 305
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-5318
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Country | US
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Telephone | 719-471-7064
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Fax | 719-776-5459
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | CRYSTAL MARIE PETERSON
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Credential |
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Telephone | 719-471-7064
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 39343
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License Number State | CO
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