Basic Information
| Provider Information | |||||||||
| NPI: | 1285121020 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SURGERY CENTER AT KISSING CAMELS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2955 PROFESSIONAL PL STE 100 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809048140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5126534730 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2955 PROFESSIONAL PL STE 100 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80904 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5126534730 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2018 | ||||||||
| LastUpdateDate: | 08/03/2018 | ||||||||
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| AuthorizedOfficialLastName: | STREIT | ||||||||
| AuthorizedOfficialFirstName: | LISA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF ADMINISTRATIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7196332494 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.