Provider Demographics
NPI:1477793578
Name:IRON HORSE PEDIATRICS
Entity Type:Organization
Organization Name:IRON HORSE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PEDIATRICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRI
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAGNALL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-633-3850
Mailing Address - Street 1:402 N TEJON ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-1142
Mailing Address - Country:US
Mailing Address - Phone:719-633-3850
Mailing Address - Fax:719-227-0840
Practice Address - Street 1:402 N TEJON ST
Practice Address - Street 2:SUITE 200
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1142
Practice Address - Country:US
Practice Address - Phone:719-633-3850
Practice Address - Fax:719-227-0840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-02
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO11820314Medicaid
CO01237718Medicaid
CO35972068Medicaid
CO01306075Medicaid
CO25386026Medicaid