Provider Demographics
NPI:1760578660
Name:MASFERRER NEUROSURGICAL, LLC
Entity Type:Organization
Organization Name:MASFERRER NEUROSURGICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIREYA
Authorized Official - Middle Name:
Authorized Official - Last Name:MASFERRER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-448-9090
Mailing Address - Street 1:306 E DEL NORTE ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-7512
Mailing Address - Country:US
Mailing Address - Phone:719-448-9090
Mailing Address - Fax:719-448-9080
Practice Address - Street 1:306 E DEL NORTE ST
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-7512
Practice Address - Country:US
Practice Address - Phone:719-448-9090
Practice Address - Fax:719-448-9080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-05
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30808207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO800124OtherMEDICARE PTAN
COE39053Medicare UPIN