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General NPI Number Information
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NPI Number | 1487026951
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Entity Type | Organization
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Legal Business Name | SURGICAL SPECIALISTS OF COLORADO PLLC
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Dates
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Enumeration Date | 10/23/2015
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Last Update Date | 03/11/2026
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Provider Practice Location Address
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Address Line | 10103 RIDGEGATE PKWY STE 309
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City | LONE TREE
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State | CO
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Zip | 80124-5525
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Country | US
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Telephone | 720-616-7835
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Fax | 303-736-4226
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Provider Business Mailing Address
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Address Line | 14100 E ARAPAHOE RD STE 260
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City | CENTENNIAL
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State | CO
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Zip | 80112-4048
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Country | US
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Telephone | 36-993-0483
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Fax | 303-699-3047
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | JACQUELYN KAY GLENN
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Credential |
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Telephone | 720-820-9455
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WW0000X
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Taxonomy Name | Wound Care Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | DR47517
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License Number State | CO
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