# PARK AVENUE SURGERY CENTER LLC

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

## Provider details

- **NPI number:** 1689748758
- **Authorized official:** DR. JERRY K POPHAM MD (PRESIDENT)
- **Authorized official phone:** (303) 468-8844

## Contact information

- **Practice address:** 1800 EMERSON ST, STE 200, DENVER, CO 80218
- **Practice address phone:** (303) 468-8844
- **Practice address fax:** (303) 468-8850
- **Mailing address:** 1800 EMERSON ST, STE 200, DENVER, CO 80218
- **Mailing address phone:** (303) 468-8844
- **Mailing address fax:** (303) 468-8850

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 0769 | CO | Yes |

## Other

- **Enumeration date:** 11/20/2006
- **Last updated:** 06/20/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 88530221 | — | CO |