MEDICARE: SURGICAL ASSOCIATES OF GREELEY

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	174400000X	Specialist

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	:	1679797732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SURGICAL ASSOCIATES OF GREELEY

Provider Business Mailing Address
First Line	:	1800 15TH ST STE 210
Second Line	:
City	:	GREELEY
State	:	CO
Zip	:	80631-4563
Country	:	US
Telephone Number	:	970-352-8216
Fax Number	:	970-352-5297

Provider Business Practice Location Address
First Line	:	1800 15TH ST STE 210
Second Line	:
City	:	GREELEY
State	:	CO
Zip	:	80631-4563
Country	:	US
Telephone Number	:	970-352-8216
Fax Number	:	970-352-5297

Authorized Official
Title or Position	:	PHYSICIAN OWNER
Name	:	JASON W OGREN
Credential	:	MD
Telephone Number	:	970-352-8216

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	04/10/2008

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