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General NPI Number Information
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NPI Number | 1912275033
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Entity Type | Organization
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Legal Business Name | EMERALD MOUNTAIN INC
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Dates
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Enumeration Date | 12/03/2011
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Last Update Date | 03/31/2016
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Provider Practice Location Address
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Address Line | 108 E CHEYENNE RD #202
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906-2504
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Country | US
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Telephone | 719-205-5114
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Fax | 719-475-1880
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Provider Business Mailing Address
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Address Line | 108 E CHEYENNE RD #202
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City | COLORADO SPRINGS
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State | CO
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Zip | 80906-2504
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Country | US
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Telephone | 719-205-5114
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Fax | 719-475-1880
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. DEBRA J WALKER
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Credential | LMT
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Telephone | 719-205-5114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | 2531
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License Number State | CO
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