Healthcare Provider Details

I. General information

NPI: 1780980466
Provider Name (Legal Business Name): SUMMIT SURGICAL SPECIALISTS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2011
Last Update Date: 01/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 PEAK ONE DRIVE SUITE 350
FRISCO CO
80443
US

IV. Provider business mailing address

PO BOX 909
COLORADO SPRINGS CO
80901-0909
US

V. Phone/Fax

Practice location:
  • Phone: 970-668-5858
  • Fax:
Mailing address:
  • Phone: 719-576-4171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number36442
License Number StateCO

VIII. Authorized Official

Name: JEFFREY LEE
Title or Position: PRESIDENT
Credential: MD
Phone: 970-668-5858