Healthcare Provider Details

I. General information

NPI: 1447364682
Provider Name (Legal Business Name): RIDGE VIEW ENDOSCOPY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 05/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10103 RIDGEGATE PKWY STE 312
LONE TREE CO
80124-5520
US

IV. Provider business mailing address

10103 RIDGEGATE PKWY STE 312
LONE TREE CO
80124-5520
US

V. Phone/Fax

Practice location:
  • Phone: 303-788-8888
  • Fax: 303-790-2567
Mailing address:
  • Phone: 303-788-8888
  • Fax: 303-790-2567

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: BONNIE BUTLER
Title or Position: MANAGER
Credential:
Phone: 303-406-4232