MEDICARE: COLORADO SURGICAL SERVICE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1215543913
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COLORADO SURGICAL SERVICE PC

Provider Business Mailing Address
First Line	:	4350 WADSWORTH BLVD STE 401
Second Line	:
City	:	WHEAT RIDGE
State	:	CO
Zip	:	80033-4638
Country	:	US
Telephone Number	:	720-996-0780
Fax Number	:

Provider Business Practice Location Address
First Line	:	2030 MOUNTAIN VIEW AVE
Second Line	:	SUITE 200
City	:	LONGMONT
State	:	CO
Zip	:	80501-3180
Country	:	US
Telephone Number	:	720-885-9600
Fax Number	:	720-885-9669

Authorized Official
Title or Position	:	CFO
Name	:	LARS ANKERSEN
Credential	:
Telephone Number	:	720-996-0780

Provider Enumeration Date	:	09/17/2020
Last Update Date	:	09/17/2020

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Directions to “COLORADO SURGICAL SERVICE PC ” Practice Location

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