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General NPI Number Information
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NPI Number | 1821950353
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Entity Type | Organization
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Legal Business Name | SALIDA GENERAL SURGERY, PLLC
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Dates
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Enumeration Date | 12/02/2025
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 1101 PINON DR
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City | PONCHA SPRINGS
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State | CO
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Zip | 81242-5084
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Country | US
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Telephone | 719-286-3170
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1295
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City | PONCHA SPRINGS
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State | CO
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Zip | 81242-1003
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Country | US
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Telephone | 719-286-3170
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Fax |
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Authorized Official
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Title or Position | GENERAL SURGEON
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Name | DR. STEFAN IVERSON
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Credential | DO
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Telephone | 719-286-3170
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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