1326132291 NPI number — MADISON STREET SURGERY CENTER, LLC

Table of content: (NPI 1326132291)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326132291 NPI number — MADISON STREET SURGERY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MADISON STREET 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:
1326132291
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/05/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 MADISON STREET
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80206-5419
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-377-2020
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
55 MADISON ST
Provider Second Line Business Practice Location Address:
200
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80206-5419
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-388-0599
Provider Business Practice Location Address Fax Number:
303-388-9805
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NEAL
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
469-214-0144

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1548219934 . This is a "NPI" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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