Healthcare Provider Details

I. General information

NPI: 1598866832
Provider Name (Legal Business Name): COLUMBINE SURGICAL ASSISTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 GORDON DR
ERIE CO
80516-7205
US

IV. Provider business mailing address

1821 GORDON DR
ERIE CO
80516-7205
US

V. Phone/Fax

Practice location:
  • Phone: 720-352-1423
  • Fax: 303-926-8207
Mailing address:
  • Phone: 720-352-1423
  • Fax: 303-926-8207

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number00F706
License Number StateCO

VIII. Authorized Official

Name: MS. KRISTENE CHAMBERS MAYER
Title or Position: SURGICAL FIRST ASSISTANT
Credential: C.F.A.
Phone: 720-352-1423