Provider Demographics
NPI:1407805948
Name:COLORADO SPRINGS NEUROLOGICAL ASSOCIATES, PC
Entity Type:Organization
Organization Name:COLORADO SPRINGS NEUROLOGICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HUMAN RESOURCES
Authorized Official - Prefix:
Authorized Official - First Name:NIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-389-1108
Mailing Address - Street 1:3464 S WILLOW ST STE 220
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4531
Mailing Address - Country:US
Mailing Address - Phone:720-248-3446
Mailing Address - Fax:719-389-1191
Practice Address - Street 1:2312 N NEVADA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-5302
Practice Address - Country:US
Practice Address - Phone:719-473-3272
Practice Address - Fax:719-389-1191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04013181Medicaid
COC95508Medicare PIN
COC97808Medicare PIN