Provider Demographics
NPI:1366830721
Name:WYOMING-COLORADO-MISSOURI SURGICAL, PLLC
Entity Type:Organization
Organization Name:WYOMING-COLORADO-MISSOURI SURGICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TRUSTEE
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JANSSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-534-0391
Mailing Address - Street 1:6870 W 52ND AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80002-3951
Mailing Address - Country:US
Mailing Address - Phone:303-534-0391
Mailing Address - Fax:303-534-0393
Practice Address - Street 1:6870 W 52ND AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-3951
Practice Address - Country:US
Practice Address - Phone:303-534-0391
Practice Address - Fax:303-534-0393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-07
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty