Basic Information
| Provider Information | |||||||||
| NPI: | 1275703910 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | UCHEALTH PIKES PEAK REGIONAL HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7901 E LOWRY BLVD | ||||||||
| Address2: | F402, 3RD FLOOR | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802306510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7205531700 | ||||||||
| FaxNumber: | 7205531754 | ||||||||
| Practice Location | |||||||||
| Address1: | 16420 WEST HIGHWAY 24 | ||||||||
| Address2: | |||||||||
| City: | WOODLAND PARK | ||||||||
| State: | CO | ||||||||
| PostalCode: | 808638760 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7196879999 | ||||||||
| FaxNumber: | 7196865725 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2008 | ||||||||
| LastUpdateDate: | 01/09/2020 | ||||||||
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| AuthorizedOfficialLastName: | MATSON | ||||||||
| AuthorizedOfficialFirstName: | DOREEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO, UCHEALTH SOUTHERN CO REGION | ||||||||
| AuthorizedOfficialTelephone: | 7193652062 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| NPICertificationDate: | 01/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | 261Q00000X | N | Ambulatory Health Care Facilities | Clinic/Center | 261QC0050X | N | Ambulatory Health Care Facilities | Clinic/Center | Critical Access Hospital | 282NC0060X | CO | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 22981551 | 05 | CO | MEDICAID | 45707324 | 05 | CO | MEDICAID | 48772585 | 05 | CO | MEDICAID | 16988752 | 05 | CO | MEDICAID |