Healthcare Provider Details

I. General information

NPI: 1124729785
Provider Name (Legal Business Name): PRIME TIME SURGICAL ASSISTING AND CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2023
Last Update Date: 05/14/2023
Certification Date: 05/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14231 E 1ST DR UNIT 203
AURORA CO
80011-3818
US

IV. Provider business mailing address

PO BOX 440216
AURORA CO
80044-0216
US

V. Phone/Fax

Practice location:
  • Phone: 720-955-0456
  • Fax:
Mailing address:
  • Phone: 720-955-0456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM JAREL GRANT
Title or Position: OWNER
Credential: CST, LSA
Phone: 720-955-0456