Provider Demographics
NPI:1992514822
Name:PIKES PEAK MED
Entity type:Organization
Organization Name:PIKES PEAK MED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/ OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DESIREE
Authorized Official - Middle Name:N
Authorized Official - Last Name:VIALPANDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-290-4379
Mailing Address - Street 1:1304 N ACADEMY BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-3318
Mailing Address - Country:US
Mailing Address - Phone:719-290-4379
Mailing Address - Fax:
Practice Address - Street 1:1304 N ACADEMY BLVD STE 102
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-3318
Practice Address - Country:US
Practice Address - Phone:719-290-4379
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-06
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty