Healthcare Provider Details

I. General information

NPI: 1194093765
Provider Name (Legal Business Name): 1ST CHOICE SURGICAL SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2011
Last Update Date: 02/17/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 N NEVADA AVE
COLORADO SPRINGS CO
80907
US

IV. Provider business mailing address

PO BOX 673
MONUMENT CO
80132-0673
US

V. Phone/Fax

Practice location:
  • Phone: 719-733-3086
  • Fax:
Mailing address:
  • Phone: 719-733-3086
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number99750
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: MARC A JOHNSON
Title or Position: OWNER
Credential: RNFA, PA-C
Phone: 719-650-7994