Healthcare Provider Details

I. General information

NPI: 1306221924
Provider Name (Legal Business Name): SURGICAL ASSISTANCE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2015
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6121 WINDEMERE RD
LOVELAND CO
80537-7012
US

IV. Provider business mailing address

6121 WINDEMERE RD
LOVELAND CO
80537-7012
US

V. Phone/Fax

Practice location:
  • Phone: 720-626-3692
  • Fax:
Mailing address:
  • Phone: 720-626-3692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number1171
License Number StateCO

VIII. Authorized Official

Name: DEBRA LINBOE
Title or Position: OWNER
Credential:
Phone: 720-626-3692