Provider Demographics
NPI:1336101765
Name:COLORADO SPRINGS ENDOCRINE CLINIC PC
Entity Type:Organization
Organization Name:COLORADO SPRINGS ENDOCRINE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:HENLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-636-3829
Mailing Address - Street 1:325 E FONTANERO ST
Mailing Address - Street 2:COLORADO SPRINGS ENDOCRINE CLINIC PC
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-7533
Mailing Address - Country:US
Mailing Address - Phone:719-636-3829
Mailing Address - Fax:719-633-8571
Practice Address - Street 1:325 E FONTANERO ST
Practice Address - Street 2:COLORADO SPRINGS ENDOCRINE CLINIC PC
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7533
Practice Address - Country:US
Practice Address - Phone:719-636-3829
Practice Address - Fax:719-633-8571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04008066Medicaid
CO04008066Medicaid