Provider Demographics
NPI:1235460908
Name:HGD SURGICAL PA SERVICES, INC.
Entity Type:Organization
Organization Name:HGD SURGICAL PA SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:HELENE
Authorized Official - Middle Name:G
Authorized Official - Last Name:DESMARAIS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:303-257-4224
Mailing Address - Street 1:11378 W RADCLIFFE DR
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-1077
Mailing Address - Country:US
Mailing Address - Phone:303-257-4224
Mailing Address - Fax:303-932-0480
Practice Address - Street 1:11378 W RADCLIFFE DR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-1077
Practice Address - Country:US
Practice Address - Phone:303-257-4224
Practice Address - Fax:303-932-0480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1582363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO55678866Medicaid
CO304993Medicare UPIN