Provider Demographics
NPI:1487688487
Name:COLORADO COUNTY SURGICAL ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:COLORADO COUNTY SURGICAL ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JULIO
Authorized Official - Middle Name:
Authorized Official - Last Name:AREBALO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-732-6552
Mailing Address - Street 1:1860 HIGHWAY 71 S
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:TX
Mailing Address - Zip Code:78934-2816
Mailing Address - Country:US
Mailing Address - Phone:979-732-6552
Mailing Address - Fax:979-732-2056
Practice Address - Street 1:1860 HIGHWAY 71 S
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:TX
Practice Address - Zip Code:78934-2816
Practice Address - Country:US
Practice Address - Phone:979-732-6552
Practice Address - Fax:979-732-2056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC7045OtherRAILROAD MEDICARE
DC7045OtherRAILROAD MEDICARE