Provider Demographics
NPI:1336343557
Name:ANDREW R ELLIAS DO PC
Entity Type:Organization
Organization Name:ANDREW R ELLIAS DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:ELLIAS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:719-540-5700
Mailing Address - Street 1:675 SOUTHPOINTE CT
Mailing Address - Street 2:STE 101
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-3887
Mailing Address - Country:US
Mailing Address - Phone:719-540-5700
Mailing Address - Fax:719-540-5702
Practice Address - Street 1:675 SOUTHPOINTE CT
Practice Address - Street 2:STE 101
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-3887
Practice Address - Country:US
Practice Address - Phone:719-540-5700
Practice Address - Fax:719-540-5702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-12
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO28329207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1740386861OtherPERSONAL NPI NUMBER
COD60829Medicare UPIN
COC535548Medicare PIN