Provider Demographics
NPI:1366406936
Name:ELECTROPHYSIOLOGY ASSOCIATES, P.C.
Entity type:Organization
Organization Name:ELECTROPHYSIOLOGY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:ALLISON
Authorized Official - Last Name:FORCINITO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-471-9942
Mailing Address - Street 1:215 PARKSIDE DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3131
Mailing Address - Country:US
Mailing Address - Phone:719-471-9942
Mailing Address - Fax:719-471-3051
Practice Address - Street 1:215 PARKSIDE DR
Practice Address - Street 2:SUITE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3131
Practice Address - Country:US
Practice Address - Phone:719-471-9942
Practice Address - Fax:719-471-3051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-12
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04010930Medicaid
CO04010930Medicaid