Provider Demographics
NPI:1275693194
Name:MULLEN, JOSEPH (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:MULLEN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3030 N CIRCLE DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1177
Mailing Address - Country:US
Mailing Address - Phone:719-776-4800
Mailing Address - Fax:719-776-4805
Practice Address - Street 1:3030 N CIRCLE DR
Practice Address - Street 2:SUITE 210
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1177
Practice Address - Country:US
Practice Address - Phone:719-776-4800
Practice Address - Fax:719-776-4805
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1577363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1851477913OtherCMH NPI
WI390848401050OtherANTHEM
WI11014110Medicaid
WIP67746Medicare UPIN
WI11014110Medicaid
WI390848401050OtherANTHEM
WI521310Medicare Oscar/Certification