# ALTITUDE SURGERY CENTER LONE TREE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396231627
- **Authorized official:** DR. BRIAN JOHN FANGMAN DDS (OWNER)
- **Authorized official phone:** (720) 328-4990

## Contact information

- **Practice address:** 10375 PARK MEADOWS DR STE 150B, LONE TREE, CO 80124-6735
- **Practice address phone:** (720) 328-4990
- **Practice address fax:** (720) 328-4994
- **Mailing address:** 10375 PARK MEADOWS DR STE 150B, LONE TREE, CO 80124-6735
- **Mailing address phone:** (720) 328-4990
- **Mailing address fax:** (720) 328-4994

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | CO | Yes |

## Other

- **Enumeration date:** 07/10/2018
- **Last updated:** 07/10/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1609027556 | INDIVIDUAL NPI | NY |
| 01 | — | 1770091720 | GROUP NPI ROBINSON AND FANGMAN COSMETIC SURGERY LONE TREE, PLLC | CO |
| 05 | — | 1952791964 | — | CO |