Provider Demographics
NPI:1982794798
Name:PEDIATRIC CARDIOLOGY ASSOCIATES
Entity Type:Organization
Organization Name:PEDIATRIC CARDIOLOGY ASSOCIATES
Other - Org Name:PEDIATRIC CARDIOLOGY ASSOCIATES LLP
Other - Org Type:Other Name
Authorized Official - Title/Position:BILLING SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MCSPARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-634-8984
Mailing Address - Street 1:1725 E BOULDER STREET
Mailing Address - Street 2:SUITE 202
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909
Mailing Address - Country:US
Mailing Address - Phone:719-634-8984
Mailing Address - Fax:719-634-7807
Practice Address - Street 1:1725 E BOULDER STREET
Practice Address - Street 2:SUITE 202
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909
Practice Address - Country:US
Practice Address - Phone:719-634-8984
Practice Address - Fax:719-634-7807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04016192Medicaid
CO04016192Medicaid
M2008Medicare UPIN