Healthcare Provider Details

I. General information

NPI: 1104782614
Provider Name (Legal Business Name): ANIMAS SURGICAL HOSPITAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2025
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 RIVERGATE LN UNIT 105
DURANGO CO
81301-7490
US

IV. Provider business mailing address

575 RIVERGATE LN UNIT 105
DURANGO CO
81301-7490
US

V. Phone/Fax

Practice location:
  • Phone: 970-259-3020
  • Fax: 970-259-9766
Mailing address:
  • Phone: 970-259-3020
  • Fax: 970-259-9766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER BOYD BALDOCK
Title or Position: OFFICER AND AUTHORIZED OFFICIAL
Credential:
Phone: 615-234-5954