Healthcare Provider Details

I. General information

NPI: 1982766895
Provider Name (Legal Business Name): COLORADO SPRINGS SURGICAL FIRST ASSISTANTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4708 VISTA VIEW LN
COLORADO SPRINGS CO
80915-1040
US

IV. Provider business mailing address

PO BOX 76510
COLORADO SPRINGS CO
80970-6510
US

V. Phone/Fax

Practice location:
  • Phone: 719-574-9889
  • Fax: 719-574-6364
Mailing address:
  • Phone: 719-638-8844
  • Fax: 719-638-8115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number69886
License Number StateCO

VIII. Authorized Official

Name: MICHAEL D MOORE
Title or Position: OWNER
Credential: RNFA
Phone: 719-574-9889