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General NPI Number Information
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NPI Number | 1417225079
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Entity Type | Organization
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Legal Business Name | ANGIE WILLIAMS SURGICAL ASSISTING, INC
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Dates
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Enumeration Date | 12/09/2011
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Last Update Date | 07/01/2020
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Provider Practice Location Address
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Address Line | 259 BEACON LITE RD
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City | MONUMENT
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State | CO
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Zip | 80132-9110
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Country | US
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Telephone | 719-457-6200
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Fax | 719-487-0005
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Provider Business Mailing Address
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Address Line | PO BOX 673
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City | MONUMENT
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State | CO
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Zip | 80132-0673
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Country | US
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Telephone | 719-457-6200
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Fax | 719-487-0005
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | ANGIE WILLIAMS
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Credential | SA
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Telephone | 719-457-6200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZS0410X
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Taxonomy Name | Surgical Technologist
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License Number | 89596
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License Number State | CO
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