Provider Demographics
NPI:1528269099
Name:COLORADO SPRINGS PULMONARY CONSULTANTS PC
Entity type:Organization
Organization Name:COLORADO SPRINGS PULMONARY CONSULTANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-471-7064
Mailing Address - Street 1:2312 N NEVADA AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-5318
Mailing Address - Country:US
Mailing Address - Phone:719-471-7064
Mailing Address - Fax:719-776-5459
Practice Address - Street 1:2312 N NEVADA AVE STE 305
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-5318
Practice Address - Country:US
Practice Address - Phone:719-471-7064
Practice Address - Fax:719-776-5459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO39343207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CU0196OtherRAILROAD MEDICARE
CO04163044Medicaid
COC16304Medicare PIN