Healthcare Provider Details

I. General information

NPI: 1356825848
Provider Name (Legal Business Name): MOUNTAIN VIEW SURGICAL ASSOCIATES-SUMMIT, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2018
Last Update Date: 07/14/2021
Certification Date: 07/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 PEAK ONE DR # 390
FRISCO CO
80443-5948
US

IV. Provider business mailing address

9399 CROWN CREST BLVD STE 220
PARKER CO
80138-8508
US

V. Phone/Fax

Practice location:
  • Phone: 303-805-1855
  • Fax: 303-805-4421
Mailing address:
  • Phone: 303-805-1855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: STACY THOUTT
Title or Position: OFFICE ADMINISTRATOR
Credential:
Phone: 303-805-1855