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General NPI Number Information
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NPI Number | 1871658658
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Entity Type | Organization
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Legal Business Name | PARKWEST SURGERY CENTER, LLC.
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Dates
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Enumeration Date | 12/22/2006
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Last Update Date | 02/04/2008
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Provider Practice Location Address
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Address Line | 3676 PARKER BLVD SUITE 140
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City | PUEBLO
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State | CO
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Zip | 81008-2212
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Country | US
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Telephone | 719-253-7032
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Fax | 719-253-7090
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Provider Business Mailing Address
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Address Line | PO BOX 17874
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City | DENVER
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State | CO
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Zip | 80217-0874
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Country | US
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Telephone | 719-253-7032
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Fax | 719-253-7090
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Authorized Official
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Title or Position | OPERATIONS MANAGER
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Name | MR. MICHAEL T. BAXTER
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Credential |
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Telephone | 719-253-7032
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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 | 0150
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License Number State | CO
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