NPIMap

Organization Active NPI

Mountain CRC Inc

  • Registered Nurse
  • Colorado Springs, CO
National Provider Identifier
1376659060
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
123859 Issued in CO
Legal business name
MOUNTAIN CRC INC
Practice address
1240 Dancing Horse Dr
Colorado Springs, CO 80919-3910
Phone
(719) 676-7060
Fax
(719) 676-7808
NPI assigned
Aug 22, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Bridget S PetersonNPI 1811948821
Title
Billing Manager
Phone
(719) 676-7060

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered NurseGroup: 193400000X SINGLE SPECIALTY GROUP 163W00000X 123859 CO Primary

Addresses

Primary practice location

1240 Dancing Horse Dr
Colorado Springs, CO 80919-3910

Mailing address

5691 Housman Ave
Pueblo, CO 81004-9709
Phone (719) 676-7060

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1156204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376659060",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5691 HOUSMAN AVE",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810049709",
            "telephone_number": "719-676-7060",
            "fax_number": "719-676-7808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1240 DANCING HORSE DR",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809193910",
            "telephone_number": "719-676-7060",
            "fax_number": "719-676-7808"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN CRC INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "BRIDGET",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "BILLING MANAGER",
        "authorized_official_telephone_number": "719-676-7060"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse",
            "state": "CO",
            "license": "123859",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Colorado Springs, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.