| Pikes Peak Internal Medicine Associates, L.l.c. | |
|
1465 Kelly Johnson Blvd Suite 310 Colorado Springs CO 80920-3955 | |
| (719) 535-8900 | |
| Not Available |
| Full Name | Pikes Peak Internal Medicine Associates, L.l.c. |
|---|---|
| Speciality | Internal Medicine |
| Location | 1465 Kelly Johnson Blvd, Colorado Springs, Colorado |
| Authorized Official Name and Position | Corinne Laurance (OWNER) |
| Authorized Official Contact | 7195358900 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Pikes Peak Internal Medicine Associates, L.l.c. 1465 Kelly Johnson Blvd Suite 310 Colorado Springs CO 80920-3955 Ph: () - | Pikes Peak Internal Medicine Associates, L.l.c. 1465 Kelly Johnson Blvd Suite 310 Colorado Springs CO 80920-3955 Ph: (719) 535-8900 |
| NPI Number | 1477742526 |
|---|---|
| Provider Enumeration Date | 10/15/2007 |
| Last Update Date | 10/15/2007 |
| Medicare PECOS PAC ID | 9032181185 |
|---|---|
| Medicare Enrollment ID | O20040809001374 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1477742526 | NPI | - | NPPES |
| 541858 | Other | CO | MEDICARE GROUP LEGACY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | 29883 (Colorado) | Primary |
| Provider Name | Dwight Alan Robertson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1740276179 PECOS PAC ID: 1951391663 Enrollment ID: I20040810001301 |
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