Provider Demographics
NPI:1780090910
Name:PIKES PEAK NEURO CARE, LLC
Entity type:Organization
Organization Name:PIKES PEAK NEURO CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENTITY OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:BENJAMIN
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:197-338-6715
Mailing Address - Street 1:PO BOX 713595 CNM-VELOCITY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-4410
Mailing Address - Country:US
Mailing Address - Phone:734-245-9892
Mailing Address - Fax:
Practice Address - Street 1:110 16TH ST STE 1460
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80202-5202
Practice Address - Country:US
Practice Address - Phone:734-245-9892
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No284300000XHospitalsSpecial HospitalGroup - Multi-Specialty