Provider Demographics
NPI:1346800737
Name:PIKES PEAK SPINE & JOINT LLC
Entity Type:Organization
Organization Name:PIKES PEAK SPINE & JOINT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:LATCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:210-615-7480
Mailing Address - Street 1:3604 GALLEY RD STE 202
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-4301
Mailing Address - Country:US
Mailing Address - Phone:719-602-3394
Mailing Address - Fax:719-602-3397
Practice Address - Street 1:3604 GALLEY RD STE 202
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-4301
Practice Address - Country:US
Practice Address - Phone:719-602-3394
Practice Address - Fax:719-602-3397
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-18
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty