Provider Demographics
NPI:1316714520
Name:COLORADO SPRINGS IV HYDRATION AND INJECTION WELLNESS CLINIC
Entity type:Organization
Organization Name:COLORADO SPRINGS IV HYDRATION AND INJECTION WELLNESS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:TAMMIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:HILLIARD
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:719-352-8362
Mailing Address - Street 1:9609 WATERBURY DR
Mailing Address - Street 2:
Mailing Address - City:PEYTON
Mailing Address - State:CO
Mailing Address - Zip Code:80831-6831
Mailing Address - Country:US
Mailing Address - Phone:719-352-8362
Mailing Address - Fax:
Practice Address - Street 1:9609 WATERBURY DR
Practice Address - Street 2:
Practice Address - City:PEYTON
Practice Address - State:CO
Practice Address - Zip Code:80831-6831
Practice Address - Country:US
Practice Address - Phone:719-352-8362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-07
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty