MEDICARE: COLORADO SPINE CARE

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
1	207R00000X	Internal Medicine Physician	32884	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164502779
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO SPINE CARE

Provider Business Mailing Address
First Line	:	3010 N CIRCLE DR STE 200-B
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1174
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3010 N CIRCLE DR STE 200-B
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1174
Country	:	US
Telephone Number	:	719-867-7373
Fax Number	:	719-867-7374

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JULIUS J BUDNICK JR.
Credential	:	M.D., P.C.
Telephone Number	:	719-867-7373

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	08/22/2020

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Directions to “COLORADO SPINE CARE ” Practice Location

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