Provider Demographics
NPI:1255913547
Name:COTTONWOOD SPRINGS PHYSICIAN GROUP LLC
Entity type:Organization
Organization Name:COTTONWOOD SPRINGS PHYSICIAN GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR. CRED. AND PAYOR ENROLLMENTS
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-400-8480
Mailing Address - Street 1:101 S 5TH ST STE 3850
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-3127
Mailing Address - Country:US
Mailing Address - Phone:412-588-3546
Mailing Address - Fax:
Practice Address - Street 1:15040 W 138TH ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-4554
Practice Address - Country:US
Practice Address - Phone:913-154-7265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPRINGSTONE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty