Provider Demographics
NPI:1649305343
Name:COLORADO PHYSICIAN SURGICAL ASST INC
Entity type:Organization
Organization Name:COLORADO PHYSICIAN SURGICAL ASST INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CSA
Authorized Official - Prefix:MR
Authorized Official - First Name:BOBBY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:FOX
Authorized Official - Suffix:
Authorized Official - Credentials:CSA
Authorized Official - Phone:720-748-2888
Mailing Address - Street 1:1673 S FLANDERS WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-5509
Mailing Address - Country:US
Mailing Address - Phone:720-748-2888
Mailing Address - Fax:303-751-1026
Practice Address - Street 1:1673 S FLANDERS WAY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80017-5509
Practice Address - Country:US
Practice Address - Phone:720-748-2888
Practice Address - Fax:303-751-1026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2013-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO92-102363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty