Provider Demographics
NPI:1548658354
Name:PIKES PEAK ORTHOPAEDIC SURGERY AND SPORTS MEDICINE, PLLC
Entity type:Organization
Organization Name:PIKES PEAK ORTHOPAEDIC SURGERY AND SPORTS MEDICINE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:B
Authorized Official - Last Name:RAHILL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-445-0344
Mailing Address - Street 1:2925 PROFESSIONAL PL STE 110
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80904-8134
Mailing Address - Country:US
Mailing Address - Phone:719-445-0344
Mailing Address - Fax:719-445-0357
Practice Address - Street 1:2925 PROFESSIONAL PL
Practice Address - Street 2:STE 110
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80904-8126
Practice Address - Country:US
Practice Address - Phone:719-445-0344
Practice Address - Fax:719-445-0357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-31
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207XX0005X
CO40753207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty