Provider Demographics
NPI:1720744568
Name:COLORADO SURGICAL AFFILIATES, LLC
Entity Type:Organization
Organization Name:COLORADO SURGICAL AFFILIATES, LLC
Other - Org Name:UROLOGICAL ASSOCIATES OF WESTERN COLORADO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-243-0900
Mailing Address - Street 1:2373 G RD STE 200
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1006
Mailing Address - Country:US
Mailing Address - Phone:970-243-3061
Mailing Address - Fax:970-245-8369
Practice Address - Street 1:2373 G RD STE 200
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81505-1006
Practice Address - Country:US
Practice Address - Phone:970-243-3061
Practice Address - Fax:970-245-8369
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLORADO SURGICAL AFFILIATES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty