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NPI Code Detail

MEDICARE: WESTSIDE WELLNESS PLLC

MEDICARE: WESTSIDE WELLNESS PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261Q00000XClinic/Center

General Provider Information

NPI Number : 1053880120
Entity Type Code : Organization
Provider Name (Legal Business Name) : WESTSIDE WELLNESS PLLC
Provider Business Mailing Address
First Line : 2020 W COLORADO AVE STE 301
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80904-3882
Country : US
Telephone Number : 719-646-6746
Fax Number : 719-473-4581
Provider Business Practice Location Address
First Line : 2020 W COLORADO AVE STE 201
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80904-3863
Country : US
Telephone Number : 719-646-6746
Fax Number : 719-434-9556
Authorized Official
Title or Position : OWNER, MANAGING MEMBER
Name : MS. JILL SMOTHERS
Credential : FNP
Telephone Number : 719-646-6746
Provider Enumeration Date : 11/19/2018
Last Update Date : 04/02/2020

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Directions to “WESTSIDE WELLNESS PLLC ” Practice Location

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