Healthcare Provider Details

I. General information

NPI: 1518296987
Provider Name (Legal Business Name): AGSA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2009
Last Update Date: 05/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

850 W HAPPY CANYON RD SUITE B
CASTLE ROCK CO
80108-3908
US

IV. Provider business mailing address

850 W HAPPY CANYON RD SUITE B
CASTLE ROCK CO
80108-3908
US

V. Phone/Fax

Practice location:
  • Phone: 303-688-5705
  • Fax: 303-688-5731
Mailing address:
  • Phone: 303-688-5705
  • Fax: 303-688-5731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. ALAN HUGO GERBHOLZ
Title or Position: DENTIST
Credential: DDS
Phone: 303-810-9176