MEDICARE: COLORADO SPRINGS OSTEOPATHIC FOUNDATION

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	204D00000X	Neuromusculoskeletal Medicine & OMM Physician

General Provider Information

NPI Number	:	1427152032
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO SPRINGS OSTEOPATHIC FOUNDATION

Provider Business Mailing Address
First Line	:	3480 CENTENNIAL BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-4087
Country	:	US
Telephone Number	:	719-635-2823
Fax Number	:	719-635-4727

Provider Business Practice Location Address
First Line	:	3480 CENTENNIAL BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-4087
Country	:	US
Telephone Number	:	719-635-2823
Fax Number	:	719-635-4727

Authorized Official
Title or Position	:	CLINIC MANAGER
Name	:	MRS. CANDIA R. BEETHE
Credential	:
Telephone Number	:	719-635-2823

Provider Enumeration Date	:	09/12/2006
Last Update Date	:	07/07/2008

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1316117575 — KATHARINE LEPPARD, M.D., P.C.
Practice Location Address:

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Practice Location Address:

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1174984587 — JESSICA M NANCE RN
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