MEDICARE: PIKES PEAK PHYSICAL MEDICINE, P.C.

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	174400000X	Specialist		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	:	1225129299
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIKES PEAK PHYSICAL MEDICINE, P.C.

Provider Business Mailing Address
First Line	:	2233 ACADEMY PL
Second Line	:	SUITE 200
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1696
Country	:	US
Telephone Number	:	719-591-0011
Fax Number	:	719-591-5540

Provider Business Practice Location Address
First Line	:	2233 ACADEMY PL
Second Line	:	SUITE 200
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80909-1696
Country	:	US
Telephone Number	:	719-591-0011
Fax Number	:	719-591-5540

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEFFREY P JENKS
Credential	:	M.D.
Telephone Number	:	719-591-0011

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	07/21/2022

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