Healthcare Provider Details

I. General information

NPI: 1265972087
Provider Name (Legal Business Name): GOLDEN RIDGE ASC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2017
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

660 GOLDEN RIDGE RD SUITE 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 Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER HARTSHORN
Title or Position: OFFICER / AUTHORIZED OFFICIAL
Credential:
Phone: 314-800-2017