Provider Demographics
NPI:1457523441
Name:SOUTHEAST DENVER ACUTE SURGICAL CONSULTANTS,LLC
Entity Type:Organization
Organization Name:SOUTHEAST DENVER ACUTE SURGICAL CONSULTANTS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BARMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-805-9802
Mailing Address - Street 1:17354 E WEAVER DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-3189
Mailing Address - Country:US
Mailing Address - Phone:303-693-0347
Mailing Address - Fax:303-693-4052
Practice Address - Street 1:17354 E WEAVER DR
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80016-3189
Practice Address - Country:US
Practice Address - Phone:303-693-0347
Practice Address - Fax:303-693-4052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO42135208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO15851842Medicaid