Provider Demographics
NPI:1437549359
Name:CENTER OF SURGICAL EXCELLENCE, LLC
Entity Type:Organization
Organization Name:CENTER OF SURGICAL EXCELLENCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BICKEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-542-1500
Mailing Address - Street 1:4100 JERRY MURPHY RD SUITE B
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001
Mailing Address - Country:US
Mailing Address - Phone:719-542-1505
Mailing Address - Fax:719-545-8626
Practice Address - Street 1:4100 JERRY MURPHY RD SUITE B
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001
Practice Address - Country:US
Practice Address - Phone:719-542-1505
Practice Address - Fax:719-545-8626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
No174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO49155041Medicaid