Healthcare Provider Details

I. General information

NPI: 1538622246
Provider Name (Legal Business Name): SURGICAL PROSPECTS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 04/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 RIDGEGATE PKWY
LONE TREE CO
80124-5522
US

IV. Provider business mailing address

9662 TIMBER HAWK CIR APT 21
HIGHLANDS RANCH CO
80126-7146
US

V. Phone/Fax

Practice location:
  • Phone: 720-225-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: NICHOLAS AGVENT
Title or Position: OWNER
Credential:
Phone: 203-592-2006