Provider Demographics
NPI:1841841194
Name:PIKES PEAK REFLUX AND WEIGHT LOSS SURGERY PLLC
Entity type:Organization
Organization Name:PIKES PEAK REFLUX AND WEIGHT LOSS SURGERY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:UNRUH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:719-650-1519
Mailing Address - Street 1:PO BOX 3525
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-3525
Mailing Address - Country:US
Mailing Address - Phone:719-377-3477
Mailing Address - Fax:
Practice Address - Street 1:6965 TUTT BLVD STE 200
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-3598
Practice Address - Country:US
Practice Address - Phone:719-377-3477
Practice Address - Fax:719-988-9705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2024-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1114996998OtherJULIE UNRUH NP
1750359642OtherROBERT WILCOX MD
CO9000178991Medicaid