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General NPI Number Information
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NPI Number | 1568571255
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Entity Type | Organization
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Legal Business Name | ATHLETIC ORTHOPAEDICS OF COLORADO SPRINGS P.C.
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Dates
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Enumeration Date | 08/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3030 N CIRCLE DR #210
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-1177
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Country | US
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Telephone | 719-635-7378
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Fax | 719-635-3009
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Provider Business Mailing Address
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Address Line | 3030 N CIRCLE DR #210
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-1177
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Country | US
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Telephone | 719-635-7378
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Fax | 719-635-3009
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Authorized Official
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Title or Position | PRESIDENT OWNER
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Name | DR. THOMAS H MAHONY III
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Credential | M.D.
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Telephone | 719-635-7378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 17403
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License Number State | CO
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