Provider Demographics
NPI:1952038259
Name:COLORADO CARDIOVASCULAR SURGICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:COLORADO CARDIOVASCULAR SURGICAL ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAWNYA
Authorized Official - Middle Name:S
Authorized Official - Last Name:WARTELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-778-6527
Mailing Address - Street 1:500 E HAMPDEN AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2885
Mailing Address - Country:US
Mailing Address - Phone:303-778-6527
Mailing Address - Fax:303-733-1288
Practice Address - Street 1:4700 HALE PKWY STE 340
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-4024
Practice Address - Country:US
Practice Address - Phone:303-778-6527
Practice Address - Fax:303-733-1288
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COLORADO CARDIOVASCULAR SURGICAL AS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-08-05
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04017786Medicaid