Traumatic Brain Injury of Southern Colorado, PC

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

Legal business name

TRAUMATIC BRAIN INJURY OF SOUTHERN COLORADO, PC

Practice address

4117 N Elizabeth St
Pueblo, CO 81008-2009

Phone

(719) 520-1102

Fax

(719) 302-6686

NPI assigned

Mar 8, 2007

Last updated

Oct 10, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

James H Evans, PHDNPI 1780716407

Title

Owner

Phone

(719) 520-1102

Specialties & licenses 1

Addresses

Practitioners 1

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.

• James H Evans, PHD

  • Clinical Neuropsychologist
  • Colorado Springs, CO
  • NPI 1780716407
  NPD (past) Authorized official

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

{
    "created_epoch": "1173312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191974400000",
    "number": "1386775781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 W BIJOU ST",
            "address_2": "SUITE C",
            "city": "COLORADO SPRINGS",
            "state": "CO",
            "postal_code": "809051309",
            "telephone_number": "719-520-1102",
            "fax_number": "719-302-6686"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4117 N ELIZABETH ST",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810082009",
            "telephone_number": "719-520-1102",
            "fax_number": "719-302-6686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TRAUMATIC BRAIN INJURY OF SOUTHERN COLORADO, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-08",
        "last_updated": "2007-10-10",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "719-520-1102",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinical Neuropsychologist in Pueblo, CO
• Providers in Pueblo, CO by specialty
• Clinical Neuropsychologist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2007; 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.