MEDICARE: THE SURGERY CENTER AT PRINTERS PARK, 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	0452	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	:	1801899794
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE SURGERY CENTER AT PRINTERS PARK, LLC

Provider Business Mailing Address
First Line	:	175 S UNION BLVD
Second Line	:	STE 100
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-3117
Country	:	US
Telephone Number	:	719-667-5800
Fax Number	:	719-667-2854

Provider Business Practice Location Address
First Line	:	175 S UNION BLVD
Second Line	:	STE 100
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80910-3117
Country	:	US
Telephone Number	:	719-667-5800
Fax Number	:	719-667-2854

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	BETH HAMSTRA
Credential	:	RN
Telephone Number	:	719-667-5792

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	11/28/2007

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