Provider Demographics
NPI:1730570946
Name:DRY SURG LLC
Entity type:Organization
Organization Name:DRY SURG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DATKHAEV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-540-7155
Mailing Address - Street 1:3715 W 95TH PL
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-2603
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3715 W 95TH PL
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-2603
Practice Address - Country:US
Practice Address - Phone:720-540-7155
Practice Address - Fax:720-540-7155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COSA#1058282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
COSA#1058 COOtherSURG ASSIST