Provider Demographics
NPI:1437627262
Name:SURGERY'S FIRST NETWORKERS LLC.
Entity Type:Organization
Organization Name:SURGERY'S FIRST NETWORKERS LLC.
Other - Org Name:SURGERY'S FIRST NETWORKERS LLC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SURGICAL ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:ADONIS
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:SR
Authorized Official - Credentials:CSFA
Authorized Official - Phone:720-939-4670
Mailing Address - Street 1:12272 JASPER ST
Mailing Address - Street 2:
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80603-7006
Mailing Address - Country:US
Mailing Address - Phone:720-939-4670
Mailing Address - Fax:
Practice Address - Street 1:12272 JASPER ST
Practice Address - Street 2:
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80603-7006
Practice Address - Country:US
Practice Address - Phone:720-939-4670
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-09
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1790807931Medicaid