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NPI Code Detail

MEDICARE: CHEYENNE MOUNTAIN GYNECOLOGY LLC

MEDICARE: CHEYENNE MOUNTAIN GYNECOLOGY LLC
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
1261QM2500XMedical Specialty Clinic/Center

General Provider Information

NPI Number : 1518612886
Entity Type Code : Organization
Provider Name (Legal Business Name) : CHEYENNE MOUNTAIN GYNECOLOGY LLC
Provider Business Mailing Address
First Line : 2874 STRATTON WOODS VW
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80906-6921
Country : US
Telephone Number : 786-493-6158
Fax Number :
Provider Business Practice Location Address
First Line : 2874 STRATTON WOODS VW
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80906-6921
Country : US
Telephone Number : 786-493-6158
Fax Number :
Authorized Official
Title or Position : EMPLOYEE
Name : STEPHANIE JEAN FINK
Credential : NP, CNM
Telephone Number : 786-493-6158
Provider Enumeration Date : 02/15/2022
Last Update Date : 02/15/2022

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Directions to “CHEYENNE MOUNTAIN GYNECOLOGY LLC ” Practice Location

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