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NPI Code Detail

MEDICARE: PIKES PEAK NEURO CARE, LLC

MEDICARE: PIKES PEAK NEURO CARE, 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
1284300000XSpecial Hospital
22084N0400XNeurology Physician

General Provider Information

NPI Number : 1780090910
Entity Type Code : Organization
Provider Name (Legal Business Name) : PIKES PEAK NEURO CARE, LLC
Provider Business Mailing Address
First Line : PO BOX 713595 CNM-VELOCITY
Second Line :
City : CHICAGO
State : IL
Zip : 60677-4410
Country : US
Telephone Number : 734-245-9892
Fax Number :
Provider Business Practice Location Address
First Line : 110 16TH ST STE 1460
Second Line :
City : DENVER
State : CO
Zip : 80202-5202
Country : US
Telephone Number : 734-245-9892
Fax Number :
Authorized Official
Title or Position : ENTITY OWNER
Name : ANDREW BENJAMIN HARRIS
Credential :
Telephone Number : 197-338-6715
Provider Enumeration Date : 07/09/2014
Last Update Date : 03/07/2025

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Directions to “PIKES PEAK NEURO CARE, LLC ” Practice Location

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