Provider Demographics
NPI:1013557362
Name:USACS OBSERVATION MEDICINE SERVICES OF COLORADO, INC.
Entity Type:Organization
Organization Name:USACS OBSERVATION MEDICINE SERVICES OF COLORADO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIC
Authorized Official - Middle Name:
Authorized Official - Last Name:BAGNOLI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-493-4443
Mailing Address - Street 1:4535 DRESSLER RD NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2545
Mailing Address - Country:US
Mailing Address - Phone:330-493-4443
Mailing Address - Fax:
Practice Address - Street 1:2222 N NEVADA AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6794
Practice Address - Country:US
Practice Address - Phone:330-493-4443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:USACS OBSERVATION MEDICINE SERVICES OF COLORADO, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty