Provider Demographics
NPI:1194729590
Name:PHYSICIANS SURGERY CENTER, LLC
Entity type:Organization
Organization Name:PHYSICIANS SURGERY CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:FURRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-903-7540
Mailing Address - Street 1:1 MERCADO STREET
Mailing Address - Street 2:SUITE 210
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301
Mailing Address - Country:US
Mailing Address - Phone:970-508-0500
Mailing Address - Fax:970-508-0505
Practice Address - Street 1:1 MERCADO ST
Practice Address - Street 2:SUITE 210
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301
Practice Address - Country:US
Practice Address - Phone:970-508-0500
Practice Address - Fax:970-508-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2013-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC804747Medicare PIN