Healthcare Provider Details

I. General information

NPI: 1033112628
Provider Name (Legal Business Name): GOLDEN RIDGE SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 08/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 GOLDEN RIDGE RD STE 110
GOLDEN CO
80401-9541
US

IV. Provider business mailing address

660 GOLDEN RIDGE RD STE 110
GOLDEN CO
80401-9541
US

V. Phone/Fax

Practice location:
  • Phone: 303-963-1500
  • Fax: 303-963-1547
Mailing address:
  • Phone: 303-963-1500
  • Fax: 303-963-1547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number160461
License Number StateCO

VIII. Authorized Official

Name: MRS. MELODIE R GARROBO
Title or Position: ADMINISTRATOR
Credential: ADMINISTRATOR
Phone: 303-963-1507