Healthcare Provider Details

I. General information

NPI: 1811148869
Provider Name (Legal Business Name): ENDOSCOPY CENTER OF THE ROCKIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2008
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 PROFESSIONAL LN STE 295
LONGMONT CO
80501-6972
US

IV. Provider business mailing address

382 S ARTHUR AVE
LOUISVILLE CO
80027-3094
US

V. Phone/Fax

Practice location:
  • Phone: 303-604-5000
  • Fax:
Mailing address:
  • Phone: 303-604-5000
  • Fax: 720-890-0364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DAUS MAHNKE
Title or Position: BOARD MEMBER
Credential:
Phone: 303-604-5000