Provider Demographics
NPI:1053904664
Name:PEDIATRIC PULMONARY AND SLEEP SPECIALISTS, PLLC
Entity type:Organization
Organization Name:PEDIATRIC PULMONARY AND SLEEP SPECIALISTS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-638-1122
Mailing Address - Street 1:9235 N UNION BLVD
Mailing Address - Street 2:STE 150 334
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7833
Mailing Address - Country:US
Mailing Address - Phone:719-638-1122
Mailing Address - Fax:719-638-1123
Practice Address - Street 1:1849 AUSTIN BLUFFS PKWY STE 150
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-7851
Practice Address - Country:US
Practice Address - Phone:719-638-1122
Practice Address - Fax:719-638-1123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-15
Last Update Date:2021-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080S0012XAllopathic & Osteopathic PhysiciansPediatricsSleep MedicineGroup - Single Specialty