MEDICARE: GOLDEN RIDGE SURGERY CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	160461	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033112628
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDEN RIDGE SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	660 GOLDEN RIDGE RD STE 110
Second Line	:
City	:	GOLDEN
State	:	CO
Zip	:	80401-9541
Country	:	US
Telephone Number	:	303-963-1500
Fax Number	:	303-963-1547

Provider Business Practice Location Address
First Line	:	660 GOLDEN RIDGE RD STE 110
Second Line	:
City	:	GOLDEN
State	:	CO
Zip	:	80401-9541
Country	:	US
Telephone Number	:	303-963-1500
Fax Number	:	303-963-1547

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. MELODIE R GARROBO
Credential	:	ADMINISTRATOR
Telephone Number	:	303-963-1507

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	08/12/2016

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