Basic Information
| Provider Information | |||||||||
| NPI: | 1417181751 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KEVIN N BATTERBEE D.O. LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 13255 HONEY RUN WAY | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809212087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7194651178 | ||||||||
| FaxNumber: | 7193587638 | ||||||||
| Practice Location | |||||||||
| Address1: | 13255 HONEY RUN WAY | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809212087 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7194651178 | ||||||||
| FaxNumber: | 7193587638 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2009 | ||||||||
| LastUpdateDate: | 05/14/2009 | ||||||||
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| AuthorizedOfficialLastName: | BATTERBEE | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | NORBERT | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7194651178 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 47335 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 1427112572 | 01 | MEDICARE NPI, INDIVIDUAL | OTHER | 4477122 | 05 | MI | MEDICAID |