Provider Demographics
NPI:1336388073
Name:FRED M FEINSOD, MD, PC
Entity Type:Organization
Organization Name:FRED M FEINSOD, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:M
Authorized Official - Last Name:FEINSOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-689-2931
Mailing Address - Street 1:9 ALTA VISTA ROAD
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80906-0009
Mailing Address - Country:US
Mailing Address - Phone:719-689-2931
Mailing Address - Fax:719-689-3702
Practice Address - Street 1:9 ALTA VISTA RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-4202
Practice Address - Country:US
Practice Address - Phone:719-689-2931
Practice Address - Fax:719-689-3702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-19
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30929314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01309293Medicaid
CO01309293Medicaid
29331Medicare PIN