Healthcare Provider Details

I. General information

NPI: 1063567402
Provider Name (Legal Business Name): NORTHERN COLORADO SURGICAL ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 01/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 E HARMONY RD SUITE 250
FORT COLLINS CO
80528-3400
US

IV. Provider business mailing address

2121 E HARMONY RD SUITE 250
FORT COLLINS CO
80528-3400
US

V. Phone/Fax

Practice location:
  • Phone: 970-482-6456
  • Fax: 970-482-3921
Mailing address:
  • Phone: 970-482-6456
  • Fax: 970-482-3921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: THOMAS G CHIAVETTA
Title or Position: DOCTOR OF MEDICINE
Credential:
Phone: 970-482-6456