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Organization

PARK AVENUE SURGERY CENTER LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JERRY K POPHAM MD (PRESIDENT)
(303) 468-8844
Entity
Organization

Contact information

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

Taxonomy

Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0769
CO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
88530221
CO
Enumeration date
11/20/2006
Last updated
06/20/2008
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