Provider Demographics
NPI:1588728737
Name:PREMIER SURGERY
Entity type:Organization
Organization Name:PREMIER SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:Y
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-795-3375
Mailing Address - Street 1:7780 S BROADWAY
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80122-2648
Mailing Address - Country:US
Mailing Address - Phone:303-795-3375
Mailing Address - Fax:303-795-0621
Practice Address - Street 1:7780 S BROADWAY
Practice Address - Street 2:SUITE 250
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80122-2648
Practice Address - Country:US
Practice Address - Phone:303-795-3375
Practice Address - Fax:303-795-0621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2008-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41224208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO62409824Medicaid
CO1588728737OtherNPI GROUP
CO1588728737OtherNPI GROUP
COH90099Medicare UPIN