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NPI Code Detail

MEDICARE: PEDIATRIC GASTROENTEROLOGY OF COLORADO SPRINGS

MEDICARE: PEDIATRIC GASTROENTEROLOGY OF COLORADO SPRINGS
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
1174400000XSpecialist35668CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1558579789
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEDIATRIC GASTROENTEROLOGY OF COLORADO SPRINGS
Provider Business Mailing Address
First Line : 2925 PROFESSIONAL PL STE 103
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80904-8125
Country : US
Telephone Number : 719-590-1000
Fax Number : 719-590-1005
Provider Business Practice Location Address
First Line : 2925 PROFESSIONAL PL STE 103
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80904-8125
Country : US
Telephone Number : 719-590-1000
Fax Number : 719-590-1005
Authorized Official
Title or Position : PRACTICE MANAGER
Name : MRS. ERIN YAZDI
Credential :
Telephone Number : 719-590-1000
Provider Enumeration Date : 05/20/2007
Last Update Date : 09/18/2012

Similar Medicare Providers

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Practice Location Address:
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1164539367 — DIANE SIMS THOMPSON M.D.
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1124344205 — THOMAS CHARLES CAUGHLAN LCSW
Practice Location Address:
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1134538630 — RACHEL LAURA HALL LPC
Practice Location Address:
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1528445004 — CATHOLIC HEALTH INITIATIVES COLORADO
Practice Location Address:
2925 PROFESSIONAL PL , STE 101
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80904-8125
Practice Phone: 719-776-6850
Practice Fax: 719-776-6855

Directions to “PEDIATRIC GASTROENTEROLOGY OF COLORADO SPRINGS ” Practice Location

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