Provider Demographics
NPI:1528141637
Name:COLORADO SURGICAL SERVICE PC
Entity type:Organization
Organization Name:COLORADO SURGICAL SERVICE PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LARS
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:ANKERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-996-0780
Mailing Address - Street 1:4350 WADSWORTH BLVD STE 401
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4638
Mailing Address - Country:US
Mailing Address - Phone:720-996-0780
Mailing Address - Fax:303-800-8381
Practice Address - Street 1:4350 WADSWORTH BLVD STE 401
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4638
Practice Address - Country:US
Practice Address - Phone:720-996-0780
Practice Address - Fax:303-800-8381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04007894Medicaid
CO04007894Medicaid