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General NPI Number Information
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NPI Number | 1891833836
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Entity Type | Organization
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Legal Business Name | PRACTITIONER HOUSE CALLS LLC
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Dates
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Enumeration Date | 02/02/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1645 FAIROAK DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-3332
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Country | US
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Telephone | 719-598-7825
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Fax | 719-637-2539
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Provider Business Mailing Address
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Address Line | 1645 FAIROAK DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80918-3332
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Country | US
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Telephone | 719-598-7825
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Fax | 719-637-2539
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD A MCCREERY
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Credential | DO
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Telephone | 719-598-7825
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | CO19454
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License Number State | CO
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