Provider Demographics
NPI:1326244054
Name:SOUTHERN COLORADO INTERNAL MEDICINE
Entity Type:Organization
Organization Name:SOUTHERN COLORADO INTERNAL MEDICINE
Other - Org Name:S. KENT OLVEY M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER, MD
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:OLVEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-955-0707
Mailing Address - Street 1:3470 CENTENNIAL BLVD
Mailing Address - Street 2:SUTIE #210
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-4090
Mailing Address - Country:US
Mailing Address - Phone:719-955-0707
Mailing Address - Fax:719-495-7333
Practice Address - Street 1:3470 CENTENNIAL BLVD
Practice Address - Street 2:SUITE #210
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4090
Practice Address - Country:US
Practice Address - Phone:719-955-0707
Practice Address - Fax:719-495-7333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-21
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO22294207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C519998Medicare PIN
D24074Medicare UPIN
C519978Medicare PIN