1144907627 NPI number — BROOMFIELD ORTHOPEDIC SURGERY CENTER, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144907627 NPI number — BROOMFIELD ORTHOPEDIC SURGERY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROOMFIELD ORTHOPEDIC SURGERY CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144907627
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4740 PEARL PKWY STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOULDER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80301-3080
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-449-2730
Provider Business Mailing Address Fax Number:
303-440-1051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1185 STATE HWY 7
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
BROOMFIELD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80023-9403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-449-2730
Provider Business Practice Location Address Fax Number:
303-449-5821
Provider Enumeration Date:
06/28/2023

Additional Information

Authorized Official

Authorized Official Last Name:
LEWIS
Authorized Official First Name:
SHERRI
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
DIRECTOR OF REVENUE CYCLE MGMT
Authorized Official Telephone Number:
720-297-0418

Provider Taxonomy Codes

  • Taxonomy code: 261QR0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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