Provider Demographics
NPI:1285822114
Name:ASPEN CREEK MEDICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:ASPEN CREEK MEDICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:KENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-278-3627
Mailing Address - Street 1:9480 BRIAR VILLAGE PT
Mailing Address - Street 2:STE. 200
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7900
Mailing Address - Country:US
Mailing Address - Phone:719-278-3627
Mailing Address - Fax:719-623-2101
Practice Address - Street 1:9480 BRIAR VILLAGE PT
Practice Address - Street 2:STE. 200
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7900
Practice Address - Country:US
Practice Address - Phone:719-278-3627
Practice Address - Fax:719-623-2101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty