Healthcare Provider Details

I. General information

NPI: 1891186987
Provider Name (Legal Business Name): FUNCTIONAL NEUROSURGICAL AMBULATORY SURGERY CENTER,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2015
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 W DRY CREEK CIR SUITE 120
LITTLETON CO
80120-8077
US

IV. Provider business mailing address

11 W DRY CREEK CIR SUITE 120
LITTLETON CO
80120-8077
US

V. Phone/Fax

Practice location:
  • Phone: 303-955-5555
  • Fax: 720-463-1090
Mailing address:
  • Phone: 303-955-5555
  • Fax: 720-463-1090

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: DR. DAVID VANSICKLE
Title or Position: OWNER
Credential: MD
Phone: 720-339-3283