Provider Demographics
NPI:1710936927
Name:WESTERN SURGICAL GROUP PC
Entity Type:Organization
Organization Name:WESTERN SURGICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:BELSHAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-870-9240
Mailing Address - Street 1:940 CENTRAL PARK DR
Mailing Address - Street 2:STE 200
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487
Mailing Address - Country:US
Mailing Address - Phone:970-870-9240
Mailing Address - Fax:970-879-6510
Practice Address - Street 1:940 CENTRAL PARK DR
Practice Address - Street 2:STE 200
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487
Practice Address - Country:US
Practice Address - Phone:970-870-9240
Practice Address - Fax:970-879-6510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2013-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01369362Medicaid
CO01369362Medicaid