MEDICARE: PIKES PEAK BOARD OF COOPERATIVE EDUCATIONAL SERVICES

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	251300000X	Local Education Agency (LEA)		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	:	1518095595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIKES PEAK BOARD OF COOPERATIVE EDUCATIONAL SERVICES

Provider Business Mailing Address
First Line	:	2883 S CIRCLE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4112
Country	:	US
Telephone Number	:	719-570-7474
Fax Number	:

Provider Business Practice Location Address
First Line	:	2883 S CIRCLE DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-4112
Country	:	US
Telephone Number	:	719-570-7474
Fax Number	:

Authorized Official
Title or Position	:	MEDICAID COORDINATOR
Name	:	LESLIE ANN BURDEKIN
Credential	:
Telephone Number	:	719-380-6218

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	02/02/2021

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