Healthcare Provider Details

I. General information

NPI: 1962958223
Provider Name (Legal Business Name): NORTHGLENN ENDOSCOPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2016
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11900 GRANT STREET #320
NORTHGLENN CO
80233
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: 720-890-0364
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 State

VIII. Authorized Official

Name: MR. DAUS MAHNKE
Title or Position: BOARD MEMEBER
Credential: MD
Phone: 303-604-5000