MEDICARE: STEPHEN J JACOBS M.D.

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	207L00000X	Anesthesiology Physician	25576	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	050048982	OTHER	CO	RAILROAD MEDICARE NUMBER

Other Identifiers

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

General Provider Information

NPI Number	:	1679566467
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN J JACOBS M.D.

Provider Business Mailing Address
First Line	:	PO BOX 820
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80901-0820
Country	:	US
Telephone Number	:	719-448-0981
Fax Number	:	719-448-0767

Provider Business Practice Location Address
First Line	:	2222 N NEVADA AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-6819
Country	:	US
Telephone Number	:	719-776-5000
Fax Number	:	719-448-0767

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	03/16/2011

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