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General NPI Number Information
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NPI Number | 1962498717
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Entity Type | Organization
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Legal Business Name | COLORADO SPRINGS PLASTIC SURGERY
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Dates
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Enumeration Date | 09/26/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2727 N TEJON ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-6231
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Country | US
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Telephone | 719-632-1818
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Fax | 719-632-4615
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Provider Business Mailing Address
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Address Line | 2727 N TEJON ST
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-6231
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Country | US
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Telephone | 719-632-1818
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Fax | 719-632-4615
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Authorized Official
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Title or Position | BILLING REPRESENTATIVE
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Name | MRS. GEORGETTE MATHEWS
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Credential |
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Telephone | 719-632-1818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | 18974
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License Number State | CO
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