Basic Information
| Provider Information | |||||||||
| NPI: | 1912388026 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SURGICAL CENTER OF PEAK ENDOSCOPY, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2920 N CASCADE AVE STE 301 | ||||||||
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| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809076265 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7196361201 | ||||||||
| FaxNumber: | 7199550986 | ||||||||
| Practice Location | |||||||||
| Address1: | 2920 N CASCADE AVE | ||||||||
| Address2: | FIRST FLOOR | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809076262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7193622300 | ||||||||
| FaxNumber: | 7193622266 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2015 | ||||||||
| LastUpdateDate: | 10/11/2019 | ||||||||
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| AuthorizedOfficialLastName: | PATEL | ||||||||
| AuthorizedOfficialFirstName: | BHAKTASHARAN | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 7193106719 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | CO | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.