Healthcare Provider Details

I. General information

NPI: 1437501145
Provider Name (Legal Business Name): NORTH CARE ASC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 01/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6071 E WOODMEN RD SUITE 352
COLORADO SPRINGS CO
80923-2607
US

IV. Provider business mailing address

6071 E WOODMEN RD SUITE 352
COLORADO SPRINGS CO
80923-2607
US

V. Phone/Fax

Practice location:
  • Phone: 719-531-7007
  • Fax: 719-531-7122
Mailing address:
  • Phone: 719-531-9794
  • Fax: 719-531-0580

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JEFFREY A MOODY
Title or Position: CEO, PRESIDENT
Credential: MD
Phone: 719-210-8818