Provider Demographics
NPI:1801081617
Name:SCOTT BRASSFIELD M.D.,P.C.
Entity type:Organization
Organization Name:SCOTT BRASSFIELD M.D.,P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:BRASSFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-574-3600
Mailing Address - Street 1:3220 N ACADEMY BLVD
Mailing Address - Street 2:5
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5115
Mailing Address - Country:US
Mailing Address - Phone:719-574-3600
Mailing Address - Fax:719-574-1686
Practice Address - Street 1:3220 N ACADEMY BLVD
Practice Address - Street 2:5
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5115
Practice Address - Country:US
Practice Address - Phone:719-574-3600
Practice Address - Fax:719-574-1686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO22644305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC1290-1Medicare PIN
COD28304Medicare UPIN