Provider Demographics
NPI:1811467517
Name:FENIX HEALTH, LLC
Entity type:Organization
Organization Name:FENIX HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:719-599-5753
Mailing Address - Street 1:3425 AUSTIN BLUFFS PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-5724
Mailing Address - Country:US
Mailing Address - Phone:719-599-5753
Mailing Address - Fax:
Practice Address - Street 1:3425 AUSTIN BLUFFS PKWY STE 205
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-5724
Practice Address - Country:US
Practice Address - Phone:719-599-5753
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-26
Last Update Date:2022-12-28
Deactivation Date:2021-09-14
Deactivation Code:
Reactivation Date:2021-10-14
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Single Specialty