Provider Demographics
NPI:1912021015
Name:PARK MEADOWS COSMETIC SURGERY, PC
Entity Type:Organization
Organization Name:PARK MEADOWS COSMETIC SURGERY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BONN
Authorized Official - Suffix:
Authorized Official - Credentials:CMPE
Authorized Official - Phone:303-706-1100
Mailing Address - Street 1:7430 PARK MEADOWS DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-2559
Mailing Address - Country:US
Mailing Address - Phone:303-706-1100
Mailing Address - Fax:303-790-7322
Practice Address - Street 1:7430 PARK MEADOWS DR
Practice Address - Street 2:SUITE 300
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-2559
Practice Address - Country:US
Practice Address - Phone:303-706-1100
Practice Address - Fax:303-790-7322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2019-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO204E00000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO472048Medicare ID - Type Unspecified