Healthcare Provider Details

I. General information

NPI: 1437746674
Provider Name (Legal Business Name): SUMMIT ORTHOPEDIC SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2020
Last Update Date: 04/22/2022
Certification Date: 04/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 DILLON RIDGE ROAD
DILLON CO
80435
US

IV. Provider business mailing address

PO BOX 6230
VAIL CO
81658-6230
US

V. Phone/Fax

Practice location:
  • Phone: 970-485-7070
  • Fax: 970-485-7039
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAUREN NOLL
Title or Position: ACCOUNTING & HIM MANAGER
Credential:
Phone: 970-477-3794