Healthcare Provider Details

I. General information

NPI: 1801381710
Provider Name (Legal Business Name): BLUE MOUNTAIN SURGICAL ASSISTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 05/08/2026
Certification Date: 05/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3154 N YORK ST
DENVER CO
80205-4167
US

IV. Provider business mailing address

PO BOX 552
EASTLAKE CO
80614-0552
US

V. Phone/Fax

Practice location:
  • Phone: 720-436-8821
  • Fax:
Mailing address:
  • Phone:
  • Fax: 720-552-7231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number13-460
License Number StateCO

VIII. Authorized Official

Name: ANTHONY FABRE
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 720-436-8821