Organization
KASIER PERMANTE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW PROVOST RN (REGISTERED NURSE)
(413) 885-0840
Entity
Organization
Contact information
Practice address
10240 PARK MEADOWS DR, LONE TREE, CO 80124-5425
(303) 338-4545
Mailing address
10240 PARK MEADOWS DR, LONE TREE, CO 80124-5425
(303) 338-4545
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
RN1640198
CO
Other
Enumeration date
03/30/2017
Last updated
03/30/2017
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