Provider Demographics
NPI:1801386644
Name:PEDIATRIC PULMONARY AND SLEEP SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:PEDIATRIC PULMONARY AND SLEEP SPECIALISTS, PLLC
Other - Org Name:PEDIATRIC SLEEP SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-638-1122
Mailing Address - Street 1:9235 N UNION BLVD STE 150334
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7831
Mailing Address - Country:US
Mailing Address - Phone:719-638-1122
Mailing Address - Fax:719-638-1123
Practice Address - Street 1:6011 E WOODMEN RD STE 115
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-2603
Practice Address - Country:US
Practice Address - Phone:719-638-1122
Practice Address - Fax:719-638-1123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-17
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.00591502080S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep MedicineGroup - Single Specialty