Provider Demographics
NPI:1851358964
Name:SURGICAL CENTER AT PREMIER LLC
Entity Type:Organization
Organization Name:SURGICAL CENTER AT PREMIER LLC
Other - Org Name:HEALTHSOUTH SURGERY CENTER OF COLORADO SPRINGS, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FETTERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-268-3200
Mailing Address - Street 1:3920 N UNION BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-4900
Mailing Address - Country:US
Mailing Address - Phone:719-268-3200
Mailing Address - Fax:
Practice Address - Street 1:3920 N UNION BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4900
Practice Address - Country:US
Practice Address - Phone:719-268-3200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16R972261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC442938Medicare PIN