Provider Demographics
NPI:1952341752
Name:INTERNAL MEDICINE OF NORTH SPRINGS, P.C.
Entity Type:Organization
Organization Name:INTERNAL MEDICINE OF NORTH SPRINGS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY OF THE CORPORATION
Authorized Official - Prefix:MR
Authorized Official - First Name:WOJCIECH
Authorized Official - Middle Name:K
Authorized Official - Last Name:KOSEK
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:719-260-8630
Mailing Address - Street 1:1910 VINDICATOR DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-3623
Mailing Address - Country:US
Mailing Address - Phone:719-260-8630
Mailing Address - Fax:719-260-8635
Practice Address - Street 1:1910 VINDICATOR DR
Practice Address - Street 2:SUITE 105
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-3623
Practice Address - Country:US
Practice Address - Phone:719-260-8630
Practice Address - Fax:719-260-8635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41419207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO99954273Medicaid
CO=========OtherTAX ID
Y48040Medicare UPIN