Provider Demographics
NPI:1083893499
Name:YOSEMITE STREET SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:YOSEMITE STREET SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAURENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLETTI
Authorized Official - Suffix:
Authorized Official - Credentials:JD-MBA
Authorized Official - Phone:303-521-2033
Mailing Address - Street 1:9777 S. YOSEMITE ST
Mailing Address - Street 2:STE 210
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-3191
Mailing Address - Country:US
Mailing Address - Phone:303-708-2943
Mailing Address - Fax:303-379-6861
Practice Address - Street 1:9777 S. YOSEMITE ST
Practice Address - Street 2:STE 210
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-3191
Practice Address - Country:US
Practice Address - Phone:303-708-2943
Practice Address - Fax:303-379-6861
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical