Healthcare Provider Details

I. General information

NPI: 1194729590
Provider Name (Legal Business Name): PHYSICIANS SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 07/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MERCADO ST SUITE 210
DURANGO CO
81301
US

IV. Provider business mailing address

1 MERCADO STREET SUITE 210
DURANGO CO
81301
US

V. Phone/Fax

Practice location:
  • Phone: 970-508-0500
  • Fax: 970-508-0505
Mailing address:
  • Phone: 970-508-0500
  • Fax: 970-508-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KIMBERLY L FURRY
Title or Position: BOARD CHAIR
Credential: MD
Phone: 970-903-7540