Healthcare Provider Details

I. General information

NPI: 1104189042
Provider Name (Legal Business Name): FOOTHILLS SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 02/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4743 ARAPAHOE AVE STE 101
BOULDER CO
80303
US

IV. Provider business mailing address

4743 ARAPAHOE AVE STE 101
BOULDER CO
80303-1123
US

V. Phone/Fax

Practice location:
  • Phone: 303-435-7161
  • Fax:
Mailing address:
  • Phone: 720-441-5757
  • Fax: 303-954-8412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LORI TAMBURO
Title or Position: ADMINISTRATOR
Credential:
Phone: 720-441-5757