Healthcare Provider Details

I. General information

NPI: 1063595221
Provider Name (Legal Business Name): SURGERY CENTER OF LOVELAND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 01/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 GRANT AVE
LOVELAND CO
80538-8412
US

IV. Provider business mailing address

3800 GRANT AVE
LOVELAND CO
80538-8412
US

V. Phone/Fax

Practice location:
  • Phone: 970-622-0608
  • Fax: 970-622-0610
Mailing address:
  • Phone: 970-622-0608
  • Fax: 970-622-0610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number1198
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number1180
License Number StateCO

VIII. Authorized Official

Name: MS. SONIA S FOOTE
Title or Position: ADMINISTRATOR
Credential: BSN RN
Phone: 970-622-0608