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General NPI Number Information
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NPI Number | 1760074744
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Entity Type | Organization
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Legal Business Name | PINE SURGICAL INSTITUTE
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Dates
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Enumeration Date | 02/10/2021
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Last Update Date | 02/10/2021
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Provider Practice Location Address
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Address Line | 10375 PARK MEADOWS DR STE 150
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City | LONE TREE
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State | CO
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Zip | 80124-6755
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Country | US
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Telephone | 480-204-4593
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Fax |
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Provider Business Mailing Address
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Address Line | 10375 PARK MEADOWS DR STE 150
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City | LONE TREE
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State | CO
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Zip | 80124-6755
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Country | US
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Telephone | 480-204-4593
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | BRANDIE HERNANDEZ
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Credential |
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Telephone | 480-204-4593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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