Organization
PIKES PEAK NEPHROLOGY ASSOCIATES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JEANINE I PITTMAN (PRACTICE ADMINISTRATOR)
(719) 632-7641
Entity
Organization
Contact information
Practice address
3326 CENTENNIAL BLVD, COLORADO SPRINGS, CO 80907-4092
(719) 257-6867
Mailing address
1914 LELARAY ST, COLORADO SPRINGS, CO 80909-2800
(719) 632-7641
(719) 632-2925
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04850046
—
CO
Enumeration date
10/27/2020
Last updated
10/27/2020
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