Provider Demographics
NPI:1629294921
Name:TERESA FEDOR, SA, INC.
Entity Type:Organization
Organization Name:TERESA FEDOR, SA, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGICAL ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FEDOR
Authorized Official - Suffix:
Authorized Official - Credentials:CSFA
Authorized Official - Phone:720-626-6807
Mailing Address - Street 1:5564 S URAVAN CT
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80015-2652
Mailing Address - Country:US
Mailing Address - Phone:720-626-6807
Mailing Address - Fax:888-399-7542
Practice Address - Street 1:5564 S URAVAN CT
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80015-2652
Practice Address - Country:US
Practice Address - Phone:720-626-6807
Practice Address - Fax:888-399-7542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSA.0001013246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty