| Lykos Medical Llc | |
|
7610 N Union Blvd Ste 150 Colorado Springs CO 80920-3800 | |
| (719) 434-8810 | |
| (833) 903-3601 |
| Full Name | Lykos Medical Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 7610 N Union Blvd Ste 150, Colorado Springs, Colorado |
| Authorized Official Name and Position | Bryan N Wogen (MANAGING PARTNER) |
| Authorized Official Contact | 7195844595 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lykos Medical Llc 7610 N Union Blvd Ste 150 Colorado Springs CO 80920-3800 Ph: (719) 434-8810 | Lykos Medical Llc 7610 N Union Blvd Ste 150 Colorado Springs CO 80920-3800 Ph: (719) 434-8810 |
| NPI Number | 1215423124 |
|---|---|
| Provider Enumeration Date | 07/03/2018 |
| Last Update Date | 05/02/2023 |
| Medicare PECOS PAC ID | 0941558035 |
|---|---|
| Medicare Enrollment ID | O20180806003125 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215423124 | NPI | - | NPPES |
| 9000163679 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Robert P Reid |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1306819453 PECOS PAC ID: 8820085830 Enrollment ID: I20111006000361 |
| Provider Name | Mallory B Martin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073154787 PECOS PAC ID: 9830518281 Enrollment ID: I20210322002500 |
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