Provider Demographics
NPI:1003415860
Name:METAMORPHOSIS LTD
Entity Type:Organization
Organization Name:METAMORPHOSIS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HESLEP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-852-3420
Mailing Address - Street 1:PO BOX 1868
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81215-1868
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6015 LEHMAN DR STE 205
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-3421
Practice Address - Country:US
Practice Address - Phone:719-896-4180
Practice Address - Fax:888-285-7140
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METAMORPHOSIS LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-22
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO57531331Medicaid
CO52939529Medicaid
CO60539577Medicaid
CO62750101Medicaid