MEDICARE: SPRINGS SOFT TISSUE, INC.

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	261QH0100X	Health Service Clinic/Center

General Provider Information

NPI Number	:	1790503290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPRINGS SOFT TISSUE, INC.

Provider Business Mailing Address
First Line	:	1840 WOODMOOR DR STE 104
Second Line	:
City	:	MONUMENT
State	:	CO
Zip	:	80132-7439
Country	:	US
Telephone Number	:	719-225-4949
Fax Number	:	719-225-4947

Provider Business Practice Location Address
First Line	:	1840 WOODMOOR DR STE 104
Second Line	:
City	:	MONUMENT
State	:	CO
Zip	:	80132-7439
Country	:	US
Telephone Number	:	719-225-4949
Fax Number	:	719-225-4947

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GROVE L HIGGINS III
Credential	:	DC
Telephone Number	:	719-225-4949

Provider Enumeration Date	:	10/02/2024
Last Update Date	:	10/23/2024

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