Provider Demographics
NPI:1801899794
Name:THE SURGERY CENTER AT PRINTERS PARK, LLC
Entity type:Organization
Organization Name:THE SURGERY CENTER AT PRINTERS PARK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMSTRA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:719-667-5792
Mailing Address - Street 1:175 S UNION BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80910-3117
Mailing Address - Country:US
Mailing Address - Phone:719-667-5800
Mailing Address - Fax:719-667-2854
Practice Address - Street 1:175 S UNION BLVD
Practice Address - Street 2:STE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3117
Practice Address - Country:US
Practice Address - Phone:719-667-5800
Practice Address - Fax:719-667-2854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0452261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO58386246Medicaid
CO58386246Medicaid