Provider Demographics
NPI:1487612792
Name:SURGICAL SPECIALISTS
Entity type:Organization
Organization Name:SURGICAL SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINSTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:HOOTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-221-5878
Mailing Address - Street 1:2315 E HARMONY RD
Mailing Address - Street 2:REDSTONE BLDG. SUITE 130
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-8620
Mailing Address - Country:US
Mailing Address - Phone:970-221-5878
Mailing Address - Fax:970-221-3564
Practice Address - Street 1:2315 E HARMONY RD
Practice Address - Street 2:REDSTONE BLDG. SUITE 130
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-8620
Practice Address - Country:US
Practice Address - Phone:970-221-5878
Practice Address - Fax:970-221-3564
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO84077271Medicaid
CO493178Medicare ID - Type Unspecified