| Centura Health Physician Group Primary Care Broadmoor | |
|
1263 Lake Plaza Dr Suite 230 Colorado Springs CO 80906-3564 | |
| (719) 776-3300 | |
| (719) 776-3329 |
| Full Name | Centura Health Physician Group Primary Care Broadmoor |
|---|---|
| Speciality | Family Medicine |
| Location | 1263 Lake Plaza Dr, Colorado Springs, Colorado |
| Authorized Official Name and Position | Angela Skinner (OMA / ADMINISTRATOR) |
| Authorized Official Contact | 3036737175 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Centura Health Physician Group Primary Care Broadmoor Po Box 911057 Denver CO 80291-1057 Ph: (303) 643-1099 | Centura Health Physician Group Primary Care Broadmoor 1263 Lake Plaza Dr Suite 230 Colorado Springs CO 80906-3564 Ph: (719) 776-3300 |
| NPI Number | 1992171219 |
|---|---|
| Provider Enumeration Date | 08/20/2015 |
| Last Update Date | 04/20/2016 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992171219 | NPI | - | NPPES |
| 50830058 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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