Provider Demographics
NPI:1285652966
Name:CK SURGICAL LLC
Entity Type:Organization
Organization Name:CK SURGICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:WILLIS
Authorized Official - Last Name:KESSLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:719-565-1000
Mailing Address - Street 1:650 DITTMER AVENUE
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81005-1212
Mailing Address - Country:US
Mailing Address - Phone:719-565-1000
Mailing Address - Fax:719-565-1111
Practice Address - Street 1:650 DITTMER AVENUE
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81005-1212
Practice Address - Country:US
Practice Address - Phone:719-565-1000
Practice Address - Fax:719-565-1111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
No2086S0105XAllopathic & Osteopathic PhysiciansSurgerySurgery of the HandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COKE32539OtherBLUE CROSS BLUE SHIELD
COKE32539OtherBLUE CROSS BLUE SHIELD