Provider Demographics
NPI:1134297427
Name:GENERAL SURGERY OF SOUTHERN COLORADO PLLC
Entity Type:Organization
Organization Name:GENERAL SURGERY OF SOUTHERN COLORADO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-561-4300
Mailing Address - Street 1:1925 E ORMAN AVE
Mailing Address - Street 2:SUITE A435
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-3537
Mailing Address - Country:US
Mailing Address - Phone:719-561-4300
Mailing Address - Fax:719-561-4303
Practice Address - Street 1:1925 E ORMAN AVE
Practice Address - Street 2:SUITE A435
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-3537
Practice Address - Country:US
Practice Address - Phone:719-561-4300
Practice Address - Fax:719-561-4303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-03
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO93787588Medicaid
CO93787588Medicaid
=========OtherTAX ID