MEDICARE: APEX ASC FORT COLLINS, 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

General Provider Information

NPI Number	:	1437885985
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	APEX ASC FORT COLLINS, LLC

Provider Business Mailing Address
First Line	:	PO BOX 5405
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-0286
Country	:	US
Telephone Number	:	678-431-1119
Fax Number	:

Provider Business Practice Location Address
First Line	:	1355 RIVERSIDE AVE
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4368
Country	:	US
Telephone Number	:	678-431-1119
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	JENNIFER HUEY
Credential	:
Telephone Number	:	678-431-1119

Provider Enumeration Date	:	07/27/2022
Last Update Date	:	07/27/2022

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