=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366065674
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTH DENVER SURGICAL SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/20/2020
-----------------------------------------------------
Last Update Date | 04/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11 W DRY CREEK CIR STE 120
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80120-8078
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-835-1129
-----------------------------------------------------
Fax | 303-835-1192
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11 W DRY CREEK CIR STE 120
-----------------------------------------------------
City | LITTLETON
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80120-8078
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LEADER OF THE PCM BILLING TEAM
-----------------------------------------------------
Name | MR. CHRISTY CHRISTOPHER
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 214-673-5147
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------