Provider Demographics
NPI:1073593901
Name:COLORADO SPRINGS VASCULAR, P.C.
Entity Type:Organization
Organization Name:COLORADO SPRINGS VASCULAR, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:CREPPS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:719-477-1033
Mailing Address - Street 1:175 S UNION BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3113
Mailing Address - Country:US
Mailing Address - Phone:719-477-1033
Mailing Address - Fax:719-477-1037
Practice Address - Street 1:175 S UNION BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3113
Practice Address - Country:US
Practice Address - Phone:719-477-1033
Practice Address - Fax:719-477-1037
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-18
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO311242086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04018016Medicaid
CO04018016Medicaid