Provider Demographics
NPI:1366530404
Name:DOCTORS MEDICAL GROUP OF COLORADO
Entity type:Organization
Organization Name:DOCTORS MEDICAL GROUP OF COLORADO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:SPEES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-531-0409
Mailing Address - Street 1:3210 N ACADEMY BLVD
Mailing Address - Street 2:STE 3
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917
Mailing Address - Country:US
Mailing Address - Phone:719-531-0409
Mailing Address - Fax:719-531-0410
Practice Address - Street 1:3210 N ACADEMY BLVD
Practice Address - Street 2:STE 3
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917
Practice Address - Country:US
Practice Address - Phone:719-531-0409
Practice Address - Fax:719-531-0410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01370998Medicaid
CO86903543Medicaid
CO387608Medicare PIN
CO86903543Medicaid
CO01370998Medicaid