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General NPI Number Information
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NPI Number | 1104993799
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Entity Type | Organization
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Legal Business Name | SURGERY CENTER OF FORT COLLINS LLC
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 11/07/2013
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Provider Practice Location Address
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Address Line | 1100 E PROSPECT RD
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City | FORT COLLINS
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State | CO
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Zip | 80525-5304
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Country | US
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Telephone | 970-494-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 1100 E PROSPECT RD
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City | FORT COLLINS
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State | CO
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Zip | 80525-5304
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | BUSINESS OFFICE MANAGER
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Name | JUDY SANSOM
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Credential |
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Telephone | 970-494-4827
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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 | 1271
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License Number State | CO
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