Healthcare Provider Details

I. General information

NPI: 1538459391
Provider Name (Legal Business Name): SIMMONS SURGICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2011
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8007 E LEHIGH DR
DENVER CO
80237-1534
US

IV. Provider business mailing address

8007 E LEHIGH DR
DENVER CO
80237-1534
US

V. Phone/Fax

Practice location:
  • Phone: 303-808-6282
  • Fax: 720-519-1471
Mailing address:
  • Phone: 303-808-6282
  • Fax: 720-519-1471

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA 9104225
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number2076
License Number StateCO

VIII. Authorized Official

Name: DEJA SIMMONS
Title or Position: CEO
Credential: PA-C
Phone: 303-808-6282