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General NPI Number Information
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NPI Number | 1730570946
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Entity Type | Organization
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Legal Business Name | DRY SURG LLC
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Dates
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Enumeration Date | 02/10/2015
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Last Update Date | 02/10/2015
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Provider Practice Location Address
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Address Line | 3715 W 95TH PL
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City | WESTMINSTER
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State | CO
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Zip | 80031-2603
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Country | US
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Telephone | 720-540-7155
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Fax | 720-540-7155
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Provider Business Mailing Address
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Address Line | 3715 W 95TH PL
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City | WESTMINSTER
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State | CO
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Zip | 80031-2603
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBEN DATKHAEV
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Credential |
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Telephone | 720-540-7155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number | SA#1058
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License Number State | CO
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