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General NPI Number Information
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NPI Number | 1962958223
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Entity Type | Organization
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Legal Business Name | NORTHGLENN ENDOSCOPY CENTER LLC
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Dates
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Enumeration Date | 08/28/2016
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Last Update Date | 03/05/2020
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Provider Practice Location Address
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Address Line | 11900 GRANT STREET #320
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City | NORTHGLENN
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State | CO
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Zip | 80233
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Country | US
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Telephone | 303-604-5000
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Fax | 720-890-0364
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Provider Business Mailing Address
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Address Line | 382 S ARTHUR AVE
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City | LOUISVILLE
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State | CO
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Zip | 80027-3094
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Country | US
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Telephone | 303-604-5000
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Fax | 720-890-0364
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Authorized Official
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Title or Position | BOARD MEMEBER
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Name | MR. DAUS MAHNKE
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Credential | MD
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Telephone | 303-604-5000
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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 |
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License Number State |
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