1679602593 NPI number — COLORADO SURGICAL SERVICE PC

Table of content: (NPI 1679602593)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679602593 NPI number — COLORADO SURGICAL SERVICE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLORADO SURGICAL SERVICE 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:
Provider Other Organization Name Type Code:
6
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:
1679602593
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4350 WADSWORTH BLVD STE 401
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHEAT RIDGE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80033-4638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-996-0780
Provider Business Mailing Address Fax Number:
303-382-9915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 INDIANA ST STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOLDEN
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80401-5027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-467-1400
Provider Business Practice Location Address Fax Number:
303-467-1467
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ANKERSEN
Authorized Official First Name:
LARS
Authorized Official Middle Name:
CHARLES
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
720-996-0780

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: 186125200 . This is a "DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 89730585 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 04007894 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: COB3508 . This is a "ANTHEM BC/BC OF CO" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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