Healthcare Provider Details

I. General information

NPI: 1700807617
Provider Name (Legal Business Name): ENDOSCOPY CENTER OF THE ROCKIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2006
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W SOUTH BOULDER RD SUITE 202
LAFAYETTE CO
80026-2752
US

IV. Provider business mailing address

382 S ARTHUR AVE
LOUISVILLE CO
80027-3094
US

V. Phone/Fax

Practice location:
  • Phone: 303-604-5000
  • Fax: 720-890-0364
Mailing address:
  • Phone: 303-604-5000
  • Fax: 720-890-0364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1064
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier95055011
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer
# 2
IdentifierEN64670
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerBCBS
# 3
Identifier490005424
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerRAILROAD MEDICARE

VIII. Authorized Official

Name: DR. DAUS MAHNKE
Title or Position: BOARD MEMBER
Credential: MD
Phone: 303-604-5000