Provider Demographics
NPI:1326229287
Name:APEX PHYSICAL MEDICINE AND REHABILITATION PROFESSIONAL LLC
Entity Type:Organization
Organization Name:APEX PHYSICAL MEDICINE AND REHABILITATION PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:BISSELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-635-3764
Mailing Address - Street 1:3910 S CAREFREE CIR STE F
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-3053
Mailing Address - Country:US
Mailing Address - Phone:719-635-3764
Mailing Address - Fax:719-635-7593
Practice Address - Street 1:3910 S CAREFREE CIR STE F
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-3053
Practice Address - Country:US
Practice Address - Phone:719-635-3764
Practice Address - Fax:719-635-7593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27753208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO6318460001Medicare NSC
COC448468Medicare PIN