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General NPI Number Information
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NPI Number | 1033112628
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Entity Type | Organization
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Legal Business Name | GOLDEN RIDGE SURGERY CENTER LLC
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Dates
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Enumeration Date | 05/27/2005
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Last Update Date | 08/12/2016
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Provider Practice Location Address
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Address Line | 660 GOLDEN RIDGE RD STE 110
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City | GOLDEN
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State | CO
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Zip | 80401-9541
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Country | US
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Telephone | 303-963-1500
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Fax | 303-963-1547
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Provider Business Mailing Address
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Address Line | 660 GOLDEN RIDGE RD STE 110
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City | GOLDEN
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State | CO
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Zip | 80401-9541
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Country | US
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Telephone | 303-963-1500
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Fax | 303-963-1547
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. MELODIE R GARROBO
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Credential | ADMINISTRATOR
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Telephone | 303-963-1507
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 160461
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License Number State | CO
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