Provider Demographics
NPI:1023239092
Name:COLORADO NEUROSURGERY ASSOCIATES, P.C.
Entity type:Organization
Organization Name:COLORADO NEUROSURGERY ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-333-8740
Mailing Address - Street 1:4600 HALE PKWY
Mailing Address - Street 2:#410
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-4020
Mailing Address - Country:US
Mailing Address - Phone:303-280-2810
Mailing Address - Fax:303-280-2876
Practice Address - Street 1:4600 HALE PKWY
Practice Address - Street 2:SUITE 410
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-4020
Practice Address - Country:US
Practice Address - Phone:303-333-8740
Practice Address - Fax:303-333-3314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2008-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO24544174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04005369Medicaid
COCH3808Medicare PIN