Healthcare Provider Details

I. General information

NPI: 1790320612
Provider Name (Legal Business Name): GS CAMPUS ASC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 01/12/2025
Certification Date: 01/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LAFAYETTE SURGERY CENTER 340 EXEMPLA CIRCLE, SUITE #400
LAFAYETTE CO
80026
US

IV. Provider business mailing address

LAFAYETTE SURGERY CENTER 340 EXEMPLA CIRCLE, SUITE #400
LAFAYETTE CO
80026
US

V. Phone/Fax

Practice location:
  • Phone: 832-472-2028
  • Fax:
Mailing address:
  • Phone: 720-673-8188
  • Fax: 720-501-6742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

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

VIII. Authorized Official

Name: KRISTINE L BERGMAN
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 303-910-1398