Basic Information
| Provider Information | |||||||||
| NPI: | 1306421268 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLORADO UROLOGIC SURGERY CENTER, LLC | ||||||||
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| OtherOrganizationName: | COLORADO UROLOGIC SURGERY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14201 DALLAS PKWY | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752542916 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4698724706 | ||||||||
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| Practice Location | |||||||||
| Address1: | 10535 PARK MEADOWS BLVD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | LONE TREE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8669533111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2021 | ||||||||
| LastUpdateDate: | 08/17/2022 | ||||||||
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| AuthorizedOfficialLastName: | BRESSMAN | ||||||||
| AuthorizedOfficialFirstName: | SARA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICER/AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 4027796135 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 08/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.