MEDICARE: PEDIATRIC PULMONARY AND SLEEP SPECIALISTS, PLLC

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	261QS1200X	Sleep Disorder Diagnostic Clinic/Center
2	2080S0012X	Pediatric Sleep Medicine Physician

General Provider Information

NPI Number	:	1801386644
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEDIATRIC PULMONARY AND SLEEP SPECIALISTS, PLLC

Provider Business Mailing Address
First Line	:	9235 N UNION BLVD STE 150334
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-7831
Country	:	US
Telephone Number	:	719-638-1122
Fax Number	:	719-638-1123

Provider Business Practice Location Address
First Line	:	6031 E WOODMEN RD STE 330
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-2624
Country	:	US
Telephone Number	:	800-506-8933
Fax Number	:	855-863-6522

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	AMANDA HARRIS
Credential	:
Telephone Number	:	719-638-1122

Provider Enumeration Date	:	05/17/2018
Last Update Date	:	07/30/2025

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