Healthcare Provider Details

I. General information

NPI: 1225341431
Provider Name (Legal Business Name): PHILLIPS SURGICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2010
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

499 E HAMPDEN AVE SUITE 380
ENGLEWOOD CO
80113-2780
US

IV. Provider business mailing address

PO BOX 909
COLORADO SPRINGS CO
80901-0909
US

V. Phone/Fax

Practice location:
  • Phone: 303-788-5300
  • Fax:
Mailing address:
  • Phone: 719-576-4171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number48890
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number48890
License Number StateCO

VIII. Authorized Official

Name: DR. BRADLEY J PHILLIPS
Title or Position: OWNER
Credential: MD
Phone: 719-576-4171