Provider Demographics
NPI:1841479862
Name:WILEY J JINKINS III MD PC
Entity type:Organization
Organization Name:WILEY J JINKINS III MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:WILEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:JINKINS
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:719-219-0914
Mailing Address - Street 1:2020 N ACADEMY BLVD
Mailing Address - Street 2:SUITE 155
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-1567
Mailing Address - Country:US
Mailing Address - Phone:719-219-0914
Mailing Address - Fax:
Practice Address - Street 1:2020 N ACADEMY BLVD
Practice Address - Street 2:SUITE 155
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1567
Practice Address - Country:US
Practice Address - Phone:719-219-0914
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-25
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C481138Medicare PIN