Provider Demographics
NPI:1164828281
Name:COLORADO SPRINGS SENIOR CARE, PLLC
Entity Type:Organization
Organization Name:COLORADO SPRINGS SENIOR CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:MESA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-500-6372
Mailing Address - Street 1:15954 JACKSON CREEK PKWY
Mailing Address - Street 2:SUITE B, #474
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-8532
Mailing Address - Country:US
Mailing Address - Phone:404-500-6372
Mailing Address - Fax:
Practice Address - Street 1:15954 JACKSON CREEK PKWY
Practice Address - Street 2:SUITE B, #474
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-8532
Practice Address - Country:US
Practice Address - Phone:404-500-6372
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO48078207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty