Provider Demographics
NPI:1285783092
Name:SPRINGS GASTROENTEROLOGY, PLLC
Entity type:Organization
Organization Name:SPRINGS GASTROENTEROLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-761-8005
Mailing Address - Street 1:PO BOX 15497
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80935-5497
Mailing Address - Country:US
Mailing Address - Phone:719-473-4030
Mailing Address - Fax:
Practice Address - Street 1:160 W FILLMORE ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6155
Practice Address - Country:US
Practice Address - Phone:719-636-1299
Practice Address - Fax:719-636-9166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO68682794Medicaid
COSPB65018OtherBLUE SHIELD
CO68682794Medicaid
COSPB65018OtherBLUE SHIELD