Provider Demographics
NPI:1346215522
Name:COLORADO SPRINGS SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:COLORADO SPRINGS SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-635-2501
Mailing Address - Street 1:PO BOX 29048
Mailing Address - Street 2:MSC # 830
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85038-9048
Mailing Address - Country:US
Mailing Address - Phone:719-635-2501
Mailing Address - Fax:719-632-1062
Practice Address - Street 1:2222 N NEVADA AVE
Practice Address - Street 2:SUITE 5017
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6831
Practice Address - Country:US
Practice Address - Phone:719-635-2501
Practice Address - Fax:719-632-1062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04006672Medicaid
COCS6266OtherRAILROAD MEDICARE
CO04006672Medicaid