=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477559839
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SURGERY CENTER OF NORTHERN COLORADO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2005
-----------------------------------------------------
Last Update Date | 02/28/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1725 E PROSPECT RD
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80525-1307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-221-2222
-----------------------------------------------------
Fax | 970-221-4286
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1725 E PROSPECT RD
-----------------------------------------------------
City | FORT COLLINS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80525-1307
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-221-2222
-----------------------------------------------------
Fax | 970-221-4286
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER SERVICES MANAGER
-----------------------------------------------------
Name | MRS. CHERYL BARBER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 970-221-2222
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | 0548
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------