MEDICARE: OAK SPRINGS FAMILY MEDICINE 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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1487868980
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OAK SPRINGS FAMILY MEDICINE PC

Provider Business Mailing Address
First Line	:	3910 S CAREFREE CIR STE C
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-3053
Country	:	US
Telephone Number	:	719-574-4780
Fax Number	:	719-574-8405

Provider Business Practice Location Address
First Line	:	3910 S CAREFREE CIR STE C
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-3053
Country	:	US
Telephone Number	:	719-574-4780
Fax Number	:	719-574-8405

Authorized Official
Title or Position	:	PRESIDENT
Name	:	GARY SAMUEL JEWELL
Credential	:	MD
Telephone Number	:	719-574-4780

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	07/18/2013

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