Provider Demographics
NPI:1891935789
Name:CITY OF COLORADO SPRINGS EMPLOYEE MEDICAL CLINIC
Entity Type:Organization
Organization Name:CITY OF COLORADO SPRINGS EMPLOYEE MEDICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RISK MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-385-5661
Mailing Address - Street 1:P.O. BOX 1575
Mailing Address - Street 2:MC135
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80901
Mailing Address - Country:US
Mailing Address - Phone:719-385-5841
Mailing Address - Fax:
Practice Address - Street 1:30 S NEVADA AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-1802
Practice Address - Country:US
Practice Address - Phone:719-385-5841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care