1548658354 NPI number — PIKES PEAK ORTHOPAEDIC SURGERY AND SPORTS MEDICINE, PLLC

Table of content: (NPI 1548658354)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548658354 NPI number — PIKES PEAK ORTHOPAEDIC SURGERY AND SPORTS MEDICINE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PIKES PEAK ORTHOPAEDIC SURGERY AND SPORTS MEDICINE, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548658354
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/18/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2925 PROFESSIONAL PL STE 110
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:
80904-8134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-445-0344
Provider Business Mailing Address Fax Number:
719-445-0357

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2925 PROFESSIONAL PL
Provider Second Line Business Practice Location Address:
STE 110
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80904-8126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-445-0344
Provider Business Practice Location Address Fax Number:
719-445-0357
Provider Enumeration Date:
12/31/2014

Additional Information

Authorized Official

Authorized Official Last Name:
RAHILL
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
B
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
719-445-0344

Provider Taxonomy Codes

  • Taxonomy code: 207XX0005X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X , with the licence number: 40753 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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