1285894634 NPI number — CENTER OF SURGICAL SPECIALISTS, PC

Table of content: (NPI 1285894634)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285894634 NPI number — CENTER OF SURGICAL SPECIALISTS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER OF SURGICAL SPECIALISTS, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
LAW-ROSENBERGER-MOORE-GEORGESCU SURGICAL ASSOCIATES, PC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285894634
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9351 GRANT ST STE 400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
THORNTON
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80229-4375
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-452-0059
Provider Business Mailing Address Fax Number:
303-452-0187

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9351 GRANT ST STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THORNTON
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80229-4375
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-452-0059
Provider Business Practice Location Address Fax Number:
303-452-6501
Provider Enumeration Date:
06/10/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GRAY
Authorized Official First Name:
LORI
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
303-452-0059

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 04014841 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".