Healthcare Provider Details

I. General information

NPI: 1063582427
Provider Name (Legal Business Name): LONGMONT SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2030 W MOUNTAIN VIEW AVE # 100
LONGMONT CO
80501
US

IV. Provider business mailing address

2030 W MOUNTAIN VIEW AVE # 100
LONGMONT CO
80501
US

V. Phone/Fax

Practice location:
  • Phone: 303-682-0375
  • Fax: 303-682-0593
Mailing address:
  • Phone: 303-682-0375
  • Fax: 303-682-0593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1112
License Number StateCO

VIII. Authorized Official

Name: SEAN MANION
Title or Position: PRESIDENT
Credential: MD
Phone: 303-682-0375