Provider Demographics
NPI:1346977865
Name:COLORADO SURGICAL SERVICE PC
Entity Type:Organization
Organization Name:COLORADO SURGICAL SERVICE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SHAWNA
Authorized Official - Middle Name:
Authorized Official - Last Name:VANSICKLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-996-0788
Mailing Address - Street 1:4350 WADSWORTH BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4638
Mailing Address - Country:US
Mailing Address - Phone:720-996-0788
Mailing Address - Fax:
Practice Address - Street 1:200 W COUNTY LINE RD STE 130
Practice Address - Street 2:
Practice Address - City:HIGHLANDS RANCH
Practice Address - State:CO
Practice Address - Zip Code:80129-2342
Practice Address - Country:US
Practice Address - Phone:303-940-8200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty