Provider Demographics
NPI:1417225079
Name:ANGIE WILLIAMS SURGICAL ASSISTING, INC
Entity Type:Organization
Organization Name:ANGIE WILLIAMS SURGICAL ASSISTING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:SA
Authorized Official - Phone:719-457-6200
Mailing Address - Street 1:PO BOX 673
Mailing Address - Street 2:
Mailing Address - City:MONUMENT
Mailing Address - State:CO
Mailing Address - Zip Code:80132-0673
Mailing Address - Country:US
Mailing Address - Phone:719-457-6200
Mailing Address - Fax:719-487-0005
Practice Address - Street 1:259 BEACON LITE RD
Practice Address - Street 2:
Practice Address - City:MONUMENT
Practice Address - State:CO
Practice Address - Zip Code:80132-9110
Practice Address - Country:US
Practice Address - Phone:719-457-6200
Practice Address - Fax:719-487-0005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-09
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO89596246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty