Provider Demographics
NPI:1851798524
Name:PROFESSIONAL ALLIANCE SURGICAL
Entity Type:Organization
Organization Name:PROFESSIONAL ALLIANCE SURGICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BEALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-716-5738
Mailing Address - Street 1:2251 S ZANG CT
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-4365
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2251 S ZANG CT
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-4365
Practice Address - Country:US
Practice Address - Phone:303-716-5738
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-25
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSA0001073246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1417919770Medicaid