MEDICARE: HARVARD PARK 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	1157	CO

General Provider Information

NPI Number	:	1366559122
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HARVARD PARK SURGERY CENTER, LLC

Provider Business Mailing Address
First Line	:	1000 E. HARVARD AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-5824
Country	:	US
Telephone Number	:	303-778-5773
Fax Number	:	303-765-3595

Provider Business Practice Location Address
First Line	:	1000 E. HARVARD AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80210-5824
Country	:	US
Telephone Number	:	303-778-5773
Fax Number	:	303-765-3595

Authorized Official
Title or Position	:	OFFICER/AUTHORIZED OFFICIAL
Name	:	PETER BLACH
Credential	:
Telephone Number	:	314-800-2017

Provider Enumeration Date	:	08/25/2006
Last Update Date	:	02/18/2025

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