Healthcare Provider Details

I. General information

NPI: 1487481032
Provider Name (Legal Business Name): SURGIASSIST LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4274 AMIABLE WAY
COLO SPGS CO
80917-1501
US

IV. Provider business mailing address

4274 AMIABLE WAY
COLO SPGS CO
80917-1501
US

V. Phone/Fax

Practice location:
  • Phone: 719-778-4229
  • Fax:
Mailing address:
  • Phone: 719-778-4229
  • 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: KRAMER HECKART
Title or Position: OWNER
Credential:
Phone: 719-778-4229