Provider Demographics
NPI:1225242258
Name:SPRINGS UROLOGY LLC
Entity Type:Organization
Organization Name:SPRINGS UROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:REIMERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-635-2503
Mailing Address - Street 1:3220 N ACADEMY BLVD
Mailing Address - Street 2:SUITE #4
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5189
Mailing Address - Country:US
Mailing Address - Phone:719-635-2503
Mailing Address - Fax:719-635-4673
Practice Address - Street 1:3220 N ACADEMY BLVD
Practice Address - Street 2:SUITE #4
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5189
Practice Address - Country:US
Practice Address - Phone:719-635-2503
Practice Address - Fax:719-635-4673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19475208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01194752Medicaid
CO5397390001Medicare NSC
CO449838Medicare ID - Type Unspecified
EO4800Medicare UPIN