Provider Demographics
NPI:1851464523
Name:CHOA MD PC
Entity Type:Organization
Organization Name:CHOA MD PC
Other - Org Name:CHILDHOOD HEMATOLOGY ONCOLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-471-2462
Mailing Address - Street 1:320 E FONTANERO ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-7529
Mailing Address - Country:US
Mailing Address - Phone:719-471-2462
Mailing Address - Fax:719-574-4974
Practice Address - Street 1:320 E FONTANERO ST
Practice Address - Street 2:SUITE 308
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7529
Practice Address - Country:US
Practice Address - Phone:303-986-9504
Practice Address - Fax:719-574-4974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1497767578OtherTHOMAS J SMITH MD
CO1497775142OtherNPI BRUCE A COOK MD
CO1417959107OtherNPI STEPHEN R PALMER MD
CO1417959107OtherNPI STEPHEN R PALMER MD
CO1497775142OtherNPI BRUCE A COOK MD
COG15897Medicare UPIN