Provider Demographics
NPI:1285894634
Name:CENTER OF SURGICAL SPECIALISTS, PC
Entity type:Organization
Organization Name:CENTER OF SURGICAL SPECIALISTS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-452-0059
Mailing Address - Street 1:9351 GRANT ST STE 400
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4375
Mailing Address - Country:US
Mailing Address - Phone:303-452-0059
Mailing Address - Fax:303-452-0187
Practice Address - Street 1:9351 GRANT ST STE 400
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4375
Practice Address - Country:US
Practice Address - Phone:303-452-0059
Practice Address - Fax:303-452-6501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-10
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04014841Medicaid