MEDICARE: NORTHWEST REGIONAL ASC, 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	16P689	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00228297	OTHER	CO	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1851399646
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHWEST REGIONAL ASC, LLC

Provider Business Mailing Address
First Line	:	10170 CHURCH RANCH WAY
Second Line	:	STE 110
City	:	WESTMINSTER
State	:	CO
Zip	:	80021-6058
Country	:	US
Telephone Number	:	303-328-3400
Fax Number	:	303-328-3401

Provider Business Practice Location Address
First Line	:	10170 CHURCH RANCH WAY
Second Line	:	STE 110
City	:	WESTMINSTER
State	:	CO
Zip	:	80021-6058
Country	:	US
Telephone Number	:	303-328-3400
Fax Number	:	303-328-3401

Authorized Official
Title or Position	:	OFFICER/AUTHORIZED OFFICIAL
Name	:	JENETHA D MORAN
Credential	:
Telephone Number	:	972-763-3893

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	12/03/2019

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