MEDICARE: DERMATOLOGY CENTER PC

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	207ND0900X	Dermatopathology Physician	22263	CO
2	207NS0135X	Procedural Dermatology Physician	22263	CO
3	207N00000X	Dermatology Physician	22263	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	:	1306968797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DERMATOLOGY CENTER PC

Provider Business Mailing Address
First Line	:	685 MISSION HILL WAY
Second Line	:
City	:	COLORADO SPGS
State	:	CO
Zip	:	80921-2671
Country	:	US
Telephone Number	:	719-488-8724
Fax Number	:	719-531-9545

Provider Business Practice Location Address
First Line	:	685 MISSION HILL WAY
Second Line	:
City	:	COLORADO SPGS
State	:	CO
Zip	:	80921-2671
Country	:	US
Telephone Number	:	719-488-8724
Fax Number	:	719-531-9545

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CHARLES G HUGHES
Credential	:	D. O.
Telephone Number	:	719-488-8724

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	03/05/2014

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Directions to “DERMATOLOGY CENTER PC ” Practice Location

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