Healthcare Provider Details

I. General information

NPI: 1235568981
Provider Name (Legal Business Name): REDLANDS MESA SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2013
Last Update Date: 09/02/2020
Certification Date: 09/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 W PARK DR
GRAND JUNCTION CO
81505-1469
US

IV. Provider business mailing address

7071 W CENTRAL AVE STE 102
TOLEDO OH
43617-2700
US

V. Phone/Fax

Practice location:
  • Phone: 970-242-0162
  • Fax: 971-242-1097
Mailing address:
  • Phone: 419-843-1369
  • Fax: 419-754-2311

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: MRS. LEILANI L HARMON
Title or Position: DIRECTOR OF BILLING AND COLLECTION
Credential:
Phone: 419-843-1369