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NPI Code Detail

MEDICARE: IGNITION PSYCHIATRY PLLC

MEDICARE: IGNITION PSYCHIATRY 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
12084P0800XPsychiatry Physician

General Provider Information

NPI Number : 1821791831
Entity Type Code : Organization
Provider Name (Legal Business Name) : IGNITION PSYCHIATRY PLLC
Provider Business Mailing Address
First Line : 5350 TOMAH DR STE 3500
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80918-6976
Country : US
Telephone Number : 719-574-6562
Fax Number : 719-475-7171
Provider Business Practice Location Address
First Line : 4760 FLINTRIDGE DR STE 250
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80918-4264
Country : US
Telephone Number : 719-268-6992
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : JEFFREY WENTZ
Credential : MD
Telephone Number : 719-574-6562
Provider Enumeration Date : 03/27/2023
Last Update Date : 05/08/2024

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Directions to “IGNITION PSYCHIATRY PLLC ” Practice Location

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