| Restore Health Family Practice | |
|
1235 Lake Plaza Dr Ste 220 Colorado Springs CO 80906-3556 | |
| (719) 292-5051 | |
| (719) 306-0183 |
| Full Name | Restore Health Family Practice |
|---|---|
| Speciality | Clinic/Center |
| Location | 1235 Lake Plaza Dr Ste 220, Colorado Springs, Colorado |
| Authorized Official Name and Position | Aleathia Ware (OWNER/OPERATOR) |
| Authorized Official Contact | 7192925051 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Restore Health Family Practice 1235 Lake Plaza Dr Ste 220 Colorado Springs CO 80906-3556 Ph: (719) 292-5051 | Restore Health Family Practice 1235 Lake Plaza Dr Ste 220 Colorado Springs CO 80906-3556 Ph: (719) 292-5051 |
| NPI Number | 1295312288 |
|---|---|
| Provider Enumeration Date | 03/25/2021 |
| Last Update Date | 12/05/2022 |
| Medicare PECOS PAC ID | 9537577762 |
|---|---|
| Medicare Enrollment ID | O20210428000012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295312288 | NPI | - | NPPES |
| 91224560 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Christine J Bong |
|---|---|
| Provider Type | Practitioner - Pediatric Medicine |
| Provider Identifiers | NPI Number: 1992827653 PECOS PAC ID: 9133261951 Enrollment ID: I20100116000197 |
| Provider Name | Aleathia Ware |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1184858581 PECOS PAC ID: 5597807503 Enrollment ID: I20100128000393 |
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