Academic Neurology & Headache Clinic PC

Primary specialty

SpecialistTaxonomy code 174400000X

License

24546 Issued in CO

Legal business name

ACADEMIC NEUROLOGY & HEADACHE CLINIC PC

Practice address

2301 E Pikes Peak Ave
Suite 202
Colorado Springs, CO 80909-8006

Phone

(719) 630-1510

Fax

(719) 632-7343

NPI assigned

Apr 24, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Bruce H Peters, M.D.

Title

President

Phone

(719) 630-1510

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177372800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260748800000",
    "number": "1083833834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2301 E PIKES PEAK AVE",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809098006",
            "telephone_number": "719-630-1510",
            "fax_number": "719-632-7343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 E PIKES PEAK AVE",
            "address_2": "SUITE 202",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809098006",
            "telephone_number": "719-630-1510",
            "fax_number": "719-632-7343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACADEMIC NEUROLOGY & HEADACHE CLINIC PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-24",
        "last_updated": "2009-12-14",
        "status": "A",
        "authorized_official_last_name": "PETERS",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "719-630-1510",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CO",
            "license": "24546",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "04016382",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Colorado Springs, CO
• Providers in Colorado Springs, CO by specialty
• Specialist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.