1093331589 NPI number — GIBSON INSTITUTE OF COGNITIVE RESEARCH

Table of content: (NPI 1093331589)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093331589 NPI number — GIBSON INSTITUTE OF COGNITIVE RESEARCH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GIBSON INSTITUTE OF COGNITIVE RESEARCH
Provider Last Name:
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Provider Gender Code:

Provider's Other Name Information

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NPI Number Information

NPI Number:
1093331589
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5085 LIST DR STE 200C
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80919-3301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-955-6716
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5085 LIST DR STE 200C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80919-3301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-955-6716
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/19/2020

Additional Information

Authorized Official

Authorized Official Last Name:
MOORE
Authorized Official First Name:
AMY
Authorized Official Middle Name:
Authorized Official Title or Position:
PSYCHOLOGIST/RESEARCH DIRECTOR
Authorized Official Telephone Number:
719-213-1052

Provider Taxonomy Codes

  • Taxonomy code: 261QR1100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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