MEDICARE: SCOTT BRASSFIELD M.D.,P.C.

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	305R00000X	Preferred Provider Organization	22644	CO

General Provider Information

NPI Number	:	1801081617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SCOTT BRASSFIELD M.D.,P.C.

Provider Business Mailing Address
First Line	:	3220 N ACADEMY BLVD
Second Line	:	5
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-5115
Country	:	US
Telephone Number	:	719-574-3600
Fax Number	:	719-574-1686

Provider Business Practice Location Address
First Line	:	3220 N ACADEMY BLVD
Second Line	:	5
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-5115
Country	:	US
Telephone Number	:	719-574-3600
Fax Number	:	719-574-1686

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	SCOTT BRASSFIELD
Credential	:	M.D.
Telephone Number	:	719-574-3600

Provider Enumeration Date	:	09/14/2007
Last Update Date	:	03/18/2009

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