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General NPI Number Information
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NPI Number | 1033249990
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Entity Type | Organization
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Legal Business Name | ASSOCIATES IN GENERAL AND VASCULAR SURGERY
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 02/26/2009
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Provider Practice Location Address
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Address Line | 1400 E BOULDER ST SUITE 600
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-5533
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Country | US
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Telephone | 719-630-8111
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 E BOULDER ST SUITE 600
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City | COLORADO SPRINGS
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State | CO
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Zip | 80909-5533
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Country | US
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Telephone | 719-630-8111
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Fax |
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | PHIL MELLA
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Credential |
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Telephone | 719-630-8111
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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