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630 Southpointe Ct Ste 105 Colorado Springs CO 80906-3800 | |
| (719) 249-8638 | |
| (719) 249-8592 |
| Full Name | |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 630 Southpointe Ct Ste 105, Colorado Springs, Colorado |
| Authorized Official Name and Position | Kelly Rae Johnson (CREDENTIALING DIRECTOR) |
| Authorized Official Contact | 7853206616 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
720 Poyntz Ave Manhattan KS 66502-6355 Ph: (785) 320-6616 | 630 Southpointe Ct Ste 105 Colorado Springs CO 80906-3800 Ph: (719) 249-8638 |
| NPI Number | 1073226858 |
|---|---|
| Provider Enumeration Date | 12/27/2022 |
| Last Update Date | 11/20/2024 |
| Certification Date | 11/20/2024 |
| Medicare PECOS PAC ID | 8022549278 |
|---|---|
| Medicare Enrollment ID | O20240930001522 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073226858 | NPI | - | NPPES |
| Provider Name | Rhonda Sims |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1043477649 PECOS PAC ID: 1658425301 Enrollment ID: I20170602001780 |
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