Healthcare Provider Details

I. General information

NPI: 1508863085
Provider Name (Legal Business Name): SPRING CREEK MEDICAL PARK OUTPATIENT SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S SHIELDS ST BLDG F
FORT COLLINS CO
80526-1827
US

IV. Provider business mailing address

2001 S SHIELDS ST BLDG F
FORT COLLINS CO
80526-1827
US

V. Phone/Fax

Practice location:
  • Phone: 970-232-1717
  • Fax: 970-488-3950
Mailing address:
  • Phone: 970-232-1717
  • Fax: 970-488-3950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0110
License Number StateCO

VIII. Authorized Official

Name: MR. JACK BURGIN
Title or Position: ADMINISTRATOR
Credential:
Phone: 970-232-1717