Provider Demographics
NPI:1073852372
Name:STEAMBOAT SPRINGS PLASTIC SURGERY CENTER
Entity Type:Organization
Organization Name:STEAMBOAT SPRINGS PLASTIC SURGERY CENTER
Other - Org Name:SCOTT M. SULENTICH MD PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:M
Authorized Official - Last Name:SULENTICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-879-4444
Mailing Address - Street 1:940 CENTRAL PARK DR STE 106
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-8853
Mailing Address - Country:US
Mailing Address - Phone:970-879-4444
Mailing Address - Fax:970-871-0662
Practice Address - Street 1:940 CENTRAL PARK DR STE 106
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-8853
Practice Address - Country:US
Practice Address - Phone:970-879-4444
Practice Address - Fax:970-871-0662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-06
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY130282500Medicaid