MEDICARE: PRACTITIONER HOUSE CALLS 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
1	207Q00000X	Family Medicine Physician	CO19454	CO

General Provider Information

NPI Number	:	1891833836
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRACTITIONER HOUSE CALLS LLC

Provider Business Mailing Address
First Line	:	1645 FAIROAK DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3332
Country	:	US
Telephone Number	:	719-598-7825
Fax Number	:	719-637-2539

Provider Business Practice Location Address
First Line	:	1645 FAIROAK DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3332
Country	:	US
Telephone Number	:	719-598-7825
Fax Number	:	719-637-2539

Authorized Official
Title or Position	:	PRESIDENT
Name	:	RICHARD A MCCREERY
Credential	:	DO
Telephone Number	:	719-598-7825

Provider Enumeration Date	:	02/02/2007
Last Update Date	:	08/22/2020

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