Healthcare Provider Details

I. General information

NPI: 1144283649
Provider Name (Legal Business Name): SKY RIDGE SURGERY CENTER LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 04/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10099 RIDGEGATE PKWY SUITE 100
LONE TREE CO
80124-5531
US

IV. Provider business mailing address

10099 RIDGEGATE PKWY SUITE 100
LONE TREE CO
80124-5531
US

V. Phone/Fax

Practice location:
  • Phone: 720-225-5000
  • Fax: 720-225-5010
Mailing address:
  • Phone: 720-225-5000
  • Fax: 720-225-5010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0343
License Number StateCO

VII. Legacy identifiers

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

# 1
Identifier23200715
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name: WILLIAM GREGORY SWINNEY
Title or Position: VP
Credential:
Phone: 615-344-5507