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NPI Code Detail

MEDICARE: PEDIATRIC ASSOCIATES, PC

MEDICARE: PEDIATRIC ASSOCIATES, PC
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
1174400000XSpecialist

General Provider Information

NPI Number : 1720085806
Entity Type Code : Organization
Provider Name (Legal Business Name) : PEDIATRIC ASSOCIATES, PC
Provider Business Mailing Address
First Line : 6190 BARNES RD
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80922-2600
Country : US
Telephone Number : 719-596-4502
Fax Number : 719-597-2668
Provider Business Practice Location Address
First Line : 6190 BARNES RD
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80922-2600
Country : US
Telephone Number : 719-596-4502
Fax Number : 719-597-2668
Authorized Official
Title or Position : OFFICE MANAGER
Name : GINNY LEARY
Credential :
Telephone Number : 719-596-6550
Provider Enumeration Date : 07/05/2005
Last Update Date : 08/22/2020

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Directions to “PEDIATRIC ASSOCIATES, PC ” Practice Location

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