| Colorado Surgical Clinic, Pc | |
|
640 Southpointe Ct 150 Colorado Springs CO 80906-3856 | |
| (719) 540-6350 | |
| (719) 527-9487 |
| Full Name | Colorado Surgical Clinic, Pc |
|---|---|
| Speciality | Dentist - Oral And Maxillofacial Surgery |
| Location | 640 Southpointe Ct, Colorado Springs, Colorado |
| Authorized Official Name and Position | Bradley W Renehan (PRESIDENT) |
| Authorized Official Contact | 7195406350 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Colorado Surgical Clinic, Pc 640 Southpointe Ct 150 Colorado Springs CO 80906-3856 Ph: (719) 540-6350 | Colorado Surgical Clinic, Pc 640 Southpointe Ct 150 Colorado Springs CO 80906-3856 Ph: (719) 540-6350 |
| NPI Number | 1598936163 |
|---|---|
| Provider Enumeration Date | 03/21/2008 |
| Last Update Date | 03/21/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598936163 | NPI | - | NPPES |
| 49086804 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 8508 (Colorado) | Primary |
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