Provider Demographics
NPI:1477763712
Name:CITY OF COLO. SPGS OCCUPATIONAL HEALTH CLINIC
Entity Type:Organization
Organization Name:CITY OF COLO. SPGS OCCUPATIONAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL HEALTH SUPERVISOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:719-385-5673
Mailing Address - Street 1:PO BOX 1575
Mailing Address - Street 2:MC 625
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80901-1575
Mailing Address - Country:US
Mailing Address - Phone:719-385-5965
Mailing Address - Fax:719-385-5678
Practice Address - Street 1:30 S NEVADA AVE
Practice Address - Street 2:SUITE 605
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1802
Practice Address - Country:US
Practice Address - Phone:719-385-5965
Practice Address - Fax:719-385-5678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2014-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine