Healthcare Provider Details

I. General information

NPI: 1053620831
Provider Name (Legal Business Name): ZURGICAL HAT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2010
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1322 N ACADEMY BLVD STE 204
COLORADO SPRINGS CO
80909-3320
US

IV. Provider business mailing address

PO BOX 76510
COLORADO SPRINGS CO
80970-6510
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number119727
License Number StateCO

VIII. Authorized Official

Name: ALICE DUNGEN
Title or Position: OWNER
Credential: CSFA
Phone: 719-638-8844