Provider Demographics
NPI:1467643692
Name:TELLER COUNTY EMERGENCY SPECIALISTS
Entity Type:Organization
Organization Name:TELLER COUNTY EMERGENCY SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:C
Authorized Official - Last Name:WEST
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:719-538-8100
Mailing Address - Street 1:1227 LAKE PLAZA DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-7402
Mailing Address - Country:US
Mailing Address - Phone:719-538-8100
Mailing Address - Fax:
Practice Address - Street 1:16420 E US HIGHWAY 24
Practice Address - Street 2:PIKES PEAK REGIONAL HOSPITAL
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80866
Practice Address - Country:US
Practice Address - Phone:719-686-0302
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherEIN