Provider Demographics
NPI:1245348226
Name:INTERNAL MEDICINE ASSOCIATES OF COLORADO SPRINGS PC
Entity type:Organization
Organization Name:INTERNAL MEDICINE ASSOCIATES OF COLORADO SPRINGS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SRIDHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-227-0027
Mailing Address - Street 1:2920 N CASCADE AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6262
Mailing Address - Country:US
Mailing Address - Phone:719-227-0027
Mailing Address - Fax:719-434-9727
Practice Address - Street 1:2920 N CASCADE AVE FL 2
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6262
Practice Address - Country:US
Practice Address - Phone:719-227-0027
Practice Address - Fax:719-434-9727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37618207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO38609347Medicaid
CO38609347Medicaid
CO804808Medicare ID - Type Unspecified