=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073852372
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEAMBOAT SPRINGS PLASTIC SURGERY CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/06/2013
-----------------------------------------------------
Last Update Date | 10/16/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 940 CENTRAL PARK DR STE 106
-----------------------------------------------------
City | STEAMBOAT SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80487-8853
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-879-4444
-----------------------------------------------------
Fax | 970-871-0662
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1180 COLLEGE DR STE 3-3
-----------------------------------------------------
City | ROCK SPRINGS
-----------------------------------------------------
State | WY
-----------------------------------------------------
Zip | 82901-5863
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 307-362-8211
-----------------------------------------------------
Fax | 307-382-3451
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | SCOTT M SULENTICH
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 970-879-4444
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------