| NPI | 1225341431 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRADLEY J PHILLIPS Owner 719-576-4171 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: CO 48890) |
| Additional Taxonomies | 2086S0102X Surgery Surgical Critical Care (Licence: CO 48890) |
| Enumeration Date | 2010-07-16 |
| Last Update Date | 2010-07-16 |