Provider Demographics
NPI:1356539605
Name:COLORADO SPRINGS COLON AND RECTAL SURGERY LLC
Entity type:Organization
Organization Name:COLORADO SPRINGS COLON AND RECTAL SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:HOUSE
Authorized Official - Last Name:JAVEED
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-475-2566
Mailing Address - Street 1:1625 MEDICAL CENTER PT
Mailing Address - Street 2:SUITE #212
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-8731
Mailing Address - Country:US
Mailing Address - Phone:719-475-2566
Mailing Address - Fax:719-475-2483
Practice Address - Street 1:1625 MEDICAL CENTER PT
Practice Address - Street 2:SUITE #212
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8731
Practice Address - Country:US
Practice Address - Phone:719-475-2566
Practice Address - Fax:719-475-2483
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARIA HOUSE-JAVEED, M.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-11
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38764208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA101879Medicare PIN
C461838Medicare PIN