Provider Demographics
NPI:1639311004
Name:HIGH COUNTRY SURGICAL ASSIST
Entity type:Organization
Organization Name:HIGH COUNTRY SURGICAL ASSIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAVENOR
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:281-462-1285
Mailing Address - Street 1:7202 BUCKINGHAM PL
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80130-4169
Mailing Address - Country:US
Mailing Address - Phone:281-462-1285
Mailing Address - Fax:281-462-1554
Practice Address - Street 1:7202 BUCKINGHAM PL
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80130-4169
Practice Address - Country:US
Practice Address - Phone:281-462-1285
Practice Address - Fax:281-462-1554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-01
Last Update Date:2009-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2703246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical AssistantGroup - Single Specialty