Colorado Facial Plastic Surgery Center Inc

Primary specialty

SpecialistTaxonomy code 174400000X

License

38335 Issued in CO

Legal business name

COLORADO FACIAL PLASTIC SURGERY CENTER INC

Practice address

3600 S Logan St
Suite 100
Englewood, CO 80113-3766

Phone

(303) 839-7980

Fax

(303) 839-7936

NPI assigned

Feb 9, 2007

Last updated

Mar 1, 2016By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mario J Imola, MD, DDSNPI 1932101490

Title

Owner

Phone

(303) 839-7980

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CO

Enrollment records 1

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Mario J Imola, MD

  • Facial Plastic Surgery Physician
  • Englewood, CO
  • NPI 1932101490
  Medicare reassignment Care Compare group NPD Authorized official
• Sydney Rae Zaransky, DO

  • Otolaryngology Physician
  • Englewood, CO
  • NPI 1194353300
  Medicare reassignment Care Compare group NPD
• David Michael Kowalczyk, M.D., M.B.A.

  • Otolaryngology Physician
  • Chicago, IL
  • NPI 1437599842

  CO

  Medicare reassignment Care Compare group NPD
• Harkaran Singh Rana, DO

  • Plastic Surgery Within the Head and Neck (Plastic Surgery) Physician
  • Tacoma, WA
  • NPI 1922508530

  CO

  Medicare reassignment NPD
• Valerie Lynn Ackman, PA-C

  • Physician Assistant
  • Englewood, CO
  • NPI 1982824504
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170979200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1456790400000",
    "number": "1114068376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3600 S LOGAN ST",
            "address_2": "SUITE 100",
            "city": "ENGLEWOOD",
            "state": "CO",
            "postal_code": "801133766",
            "telephone_number": "303-839-7980",
            "fax_number": "303-839-7936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 S LOGAN ST",
            "address_2": "SUITE 100",
            "city": "ENGLEWOOD",
            "state": "CO",
            "postal_code": "801133766",
            "telephone_number": "303-839-7980",
            "fax_number": "303-839-7936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COLORADO FACIAL PLASTIC SURGERY CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-09",
        "last_updated": "2016-03-01",
        "status": "A",
        "authorized_official_last_name": "IMOLA",
        "authorized_official_first_name": "MARIO",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "303-839-7980",
        "authorized_official_credential": "MD, DDS"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CO",
            "license": "38335",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "IM642698",
            "state": "CO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "08671281",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Englewood, CO
• Providers in Englewood, CO by specialty
• Specialist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.