Provider Demographics
NPI:1669105623
Name:PIKES PEAK CENTER FOR REGENERATIVE MEDICINE, LLC
Entity type:Organization
Organization Name:PIKES PEAK CENTER FOR REGENERATIVE MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAME
Authorized Official - Middle Name:
Authorized Official - Last Name:AUST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-219-9819
Mailing Address - Street 1:162 TRACKER DR STE 120
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-1006
Mailing Address - Country:US
Mailing Address - Phone:719-219-9819
Mailing Address - Fax:
Practice Address - Street 1:162 TRACKER DR STE 120
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80921-1006
Practice Address - Country:US
Practice Address - Phone:719-219-9819
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-07
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty