Provider Demographics
NPI:1184645418
Name:SANGRE DE CRISTO SURGICAL ASSOCIATES, PC
Entity type:Organization
Organization Name:SANGRE DE CRISTO SURGICAL ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERNEST
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:STEINLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-545-8240
Mailing Address - Street 1:1600 N GRAND AVE
Mailing Address - Street 2:SUITE 430
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81003-2700
Mailing Address - Country:US
Mailing Address - Phone:719-545-8240
Mailing Address - Fax:719-545-4319
Practice Address - Street 1:1600 N GRAND AVE
Practice Address - Street 2:SUITE 430
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81003-2700
Practice Address - Country:US
Practice Address - Phone:719-545-8240
Practice Address - Fax:719-545-4319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04020244Medicaid
COU7408Medicare ID - Type Unspecified