Provider Demographics
NPI:1306968797
Name:DERMATOLOGY CENTER PC
Entity type:Organization
Organization Name:DERMATOLOGY CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:G
Authorized Official - Last Name:HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:D O
Authorized Official - Phone:719-488-8724
Mailing Address - Street 1:685 MISSION HILL WAY
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-2671
Mailing Address - Country:US
Mailing Address - Phone:719-488-8724
Mailing Address - Fax:719-531-9545
Practice Address - Street 1:685 MISSION HILL WAY
Practice Address - Street 2:
Practice Address - City:COLORADO SPGS
Practice Address - State:CO
Practice Address - Zip Code:80921-2671
Practice Address - Country:US
Practice Address - Phone:719-488-8724
Practice Address - Fax:719-531-9545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO22263207ND0900X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathologyGroup - Single Specialty
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04012936Medicaid
CO5322Medicare PIN