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General NPI Number Information
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NPI Number | 1942207196
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Entity Type | Organization
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Legal Business Name | GRAND VALLEY SURGICAL CENTER, LLC
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Dates
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Enumeration Date | 07/01/2005
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Last Update Date | 09/11/2018
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Provider Practice Location Address
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Address Line | 710 WELLINGTON AVE STE 21
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-6102
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Country | US
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Telephone | 970-298-7800
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Fax | 970-298-7850
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Provider Business Mailing Address
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Address Line | 710 WELLINGTON AVE STE 21
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City | GRAND JUNCTION
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State | CO
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Zip | 81501-6102
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Country | US
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Telephone | 970-298-7800
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Fax | 970-298-7850
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MITCHELL SCHWARZBACH
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Credential |
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Telephone | 970-298-7822
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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 | 1611ND
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License Number State | CO
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