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General NPI Number Information
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NPI Number | 1316056260
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Entity Type | Organization
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Legal Business Name | ST. VRAIN SURGICAL ASSISTS, LLC
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 11/06/2007
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Provider Practice Location Address
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Address Line | 77 BAYLOR DR
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City | LONGMONT
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State | CO
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Zip | 80503-2148
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Country | US
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Telephone | 303-819-2025
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Fax | 720-494-0995
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Provider Business Mailing Address
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Address Line | 77 BAYLOR DR
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City | LONGMONT
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State | CO
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Zip | 80503-2148
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Country | US
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Telephone | 303-819-2025
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Fax | 720-494-0995
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Authorized Official
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Title or Position | OWNER/MGR
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Name | MR. BILL J PARKER
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Credential | PA/C
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Telephone | 303-819-2025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 519
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License Number State | CO
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