1497085377 NPI number — PRECISE SURGICAL OF DENVER LLC

Table of content: (NPI 1497085377)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497085377 NPI number — PRECISE SURGICAL OF DENVER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRECISE SURGICAL OF DENVER LLC
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:
Provider Other Organization Name Type Code:
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:
1497085377
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/29/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1940 S LANSING CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80014-1056
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-201-3690
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1719 E 19TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80218-1235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-839-6000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/28/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BACHAYEV
Authorized Official First Name:
ROMAN
Authorized Official Middle Name:
Authorized Official Title or Position:
SA-C
Authorized Official Telephone Number:
720-201-3690

Provider Taxonomy Codes

  • Taxonomy code: 246ZC0007X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 273Y00000X , with the licence number: 09264 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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