Provider Demographics
NPI:1427584069
Name:STEWART SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:STEWART SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:ODELL
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:CST/CSFA
Authorized Official - Phone:970-986-7887
Mailing Address - Street 1:3099 CEDAR DR
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81504-5623
Mailing Address - Country:US
Mailing Address - Phone:970-986-7887
Mailing Address - Fax:951-587-8277
Practice Address - Street 1:3099 CEDAR DR
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81504-5623
Practice Address - Country:US
Practice Address - Phone:970-986-7887
Practice Address - Fax:951-587-8277
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-02
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO171979246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty