Organization
PARK AVENUE SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY KIRK POPHAM M.D. (PHYSICIAN)
(303) 468-8844
Entity
Organization
Contact information
Practice address
1800 EMERSON ST, #220, DENVER, CO 80218-1014
(303) 468-8844
(303) 468-8850
Mailing address
1800 EMERSON ST, #200, DENVER, CO 80218-1014
(303) 468-8844
(303) 468-8850
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0471
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0471
STATE LICENSE
CO
Enumeration date
06/30/2005
Last updated
08/22/2020
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