| Dr. Moma Llc | |
|
411 Lakewood Cir Ste B114 Colorado Springs CO 80910-4629 | |
| (719) 597-4768 | |
| (719) 591-2309 |
| Full Name | Dr. Moma Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 411 Lakewood Cir Ste B114, Colorado Springs, Colorado |
| Authorized Official Name and Position | Sylvienash Moma (OWNER) |
| Authorized Official Contact | 7196469834 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Moma Llc 411 Lakewood Cir Ste B114 Colorado Springs CO 80910-4629 Ph: (719) 597-4768 | Dr. Moma Llc 411 Lakewood Cir Ste B114 Colorado Springs CO 80910-4629 Ph: (719) 597-4768 |
| NPI Number | 1457961864 |
|---|---|
| Provider Enumeration Date | 07/31/2020 |
| Last Update Date | 08/03/2020 |
| Medicare PECOS PAC ID | 7719392232 |
|---|---|
| Medicare Enrollment ID | O20210216001068 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457961864 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Sylvienash B Moma |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1922565464 PECOS PAC ID: 6800201328 Enrollment ID: I20210216001256 |
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