Healthcare Provider Details

I. General information

NPI: 1326132291
Provider Name (Legal Business Name): MADISON STREET SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 MADISON ST 200
DENVER CO
80206-5419
US

IV. Provider business mailing address

55 MADISON STREET SUITE 200
DENVER CO
80206-5419
US

V. Phone/Fax

Practice location:
  • Phone: 303-388-0599
  • Fax: 303-388-9805
Mailing address:
  • Phone: 303-377-2020
  • Fax:

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: GEORGE L NEAL
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 469-214-0144