1952099749 NPI number — COLORADO OTOLARYNGOLOGY ASSOCIATES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952099749 NPI number — COLORADO OTOLARYNGOLOGY ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLORADO OTOLARYNGOLOGY ASSOCIATES
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:
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:
1952099749
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9190
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:
80932
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-867-7800
Provider Business Mailing Address Fax Number:
719-867-7899

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3595 E. SPAULDING AVENUE
Provider Second Line Business Practice Location Address:
STE. B
Provider Business Practice Location Address City Name:
PUEBLO
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
81008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-867-7800
Provider Business Practice Location Address Fax Number:
719-867-7899
Provider Enumeration Date:
04/28/2023

Additional Information

Authorized Official

Authorized Official Last Name:
LAZARUS
Authorized Official First Name:
NOAH
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
719-867-7800

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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