MEDICARE: COLORADO SPRINGS NEUROLOGICAL ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	103G00000X	Clinical Neuropsychologist
2	103TC0700X	Clinical Psychologist
3	207T00000X	Neurological Surgery Physician
4	2084N0400X	Neurology Physician

General Provider Information

NPI Number	:	1518745298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO SPRINGS NEUROLOGICAL ASSOCIATES

Provider Business Mailing Address
First Line	:	5725 MARK DABLING BLVD
Second Line	:	STE 100
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-2221
Country	:	US
Telephone Number	:	719-473-3272
Fax Number	:	719-389-1191

Provider Business Practice Location Address
First Line	:	5725 MARK DABLING BLVD
Second Line	:	STE 100
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-2221
Country	:	US
Telephone Number	:	719-473-3272
Fax Number	:	719-389-1191

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RONALD HAMMERS
Credential	:	MD
Telephone Number	:	719-473-3272

Provider Enumeration Date	:	09/15/2023
Last Update Date	:	05/03/2024

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