Provider Demographics
NPI:1346273521
Name:PIKES PEAK ALLERGY & ASTHMA
Entity Type:Organization
Organization Name:PIKES PEAK ALLERGY & ASTHMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:NATHANAEL
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:BRADY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:719-260-1022
Mailing Address - Street 1:595 CHAPEL HILLS DR
Mailing Address - Street 2:102
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-1024
Mailing Address - Country:US
Mailing Address - Phone:719-578-0909
Mailing Address - Fax:719-260-7790
Practice Address - Street 1:595 CHAPEL HILLS DR
Practice Address - Street 2:102
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-1024
Practice Address - Country:US
Practice Address - Phone:719-578-0909
Practice Address - Fax:719-260-7790
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO83737049Medicaid
CO83737049Medicaid