Healthcare Provider Details

I. General information

NPI: 1770180986
Provider Name (Legal Business Name): AUDUBON AMBULATORY SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2020
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6011 E WOODMEN RD STE 200
COLORADO SPRINGS CO
80923-2604
US

IV. Provider business mailing address

6011 E WOODMEN RD STE 200
COLORADO SPRINGS CO
80923-2604
US

V. Phone/Fax

Practice location:
  • Phone: 719-355-3400
  • Fax: 719-355-3398
Mailing address:
  • Phone: 719-355-3400
  • Fax: 719-355-3398

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: CHRISTOPHER HARTSHORN
Title or Position: OFFICER/AUTHOIZED OFFICIAL
Credential:
Phone: 314-800-2017