Provider Demographics
NPI:1184800757
Name:STILL POINT MEDICAL CLINIC, INC.
Entity type:Organization
Organization Name:STILL POINT MEDICAL CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ADRIENNE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KANIA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:719-385-0600
Mailing Address - Street 1:1430 S. 21ST STREET
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-4279
Mailing Address - Country:US
Mailing Address - Phone:719-385-0600
Mailing Address - Fax:719-385-0601
Practice Address - Street 1:1430 S. 21ST STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-4279
Practice Address - Country:US
Practice Address - Phone:719-385-0600
Practice Address - Fax:719-385-0601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2009-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO207Q00000X
CO31196204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01311968Medicaid
COF57300Medicare UPIN
CO01311968Medicaid