Healthcare Provider Details

I. General information

NPI: 1053711275
Provider Name (Legal Business Name): ASC LONE TREE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2014
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10520 EL DIENTE CT
ENGLEWOOD CO
80112-2656
US

IV. Provider business mailing address

3900 E MEXICO AVE STE 102
DENVER CO
80210-3941
US

V. Phone/Fax

Practice location:
  • Phone: 720-524-1001
  • Fax: 720-524-1121
Mailing address:
  • Phone: 303-800-2078
  • Fax: 303-800-2078

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: CHRISTIAN ELLISON
Title or Position: CEO
Credential:
Phone: 720-273-7449