Provider Demographics
NPI:1871658658
Name:PARKWEST SURGERY CENTER, LLC.
Entity Type:Organization
Organization Name:PARKWEST SURGERY CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:BAXTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-253-7032
Mailing Address - Street 1:PO BOX 17874
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-0874
Mailing Address - Country:US
Mailing Address - Phone:719-253-7032
Mailing Address - Fax:719-253-7090
Practice Address - Street 1:3676 PARKER BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2212
Practice Address - Country:US
Practice Address - Phone:719-253-7032
Practice Address - Fax:719-253-7090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0150261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO79103731Medicaid
CO79103731Medicaid