Provider Demographics
NPI:1033112628
Name:GOLDEN RIDGE SURGERY CENTER LLC
Entity Type:Organization
Organization Name:GOLDEN RIDGE SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELODIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:GARROBO
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:303-963-1507
Mailing Address - Street 1:660 GOLDEN RIDGE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-9541
Mailing Address - Country:US
Mailing Address - Phone:303-963-1500
Mailing Address - Fax:303-963-1547
Practice Address - Street 1:660 GOLDEN RIDGE RD STE 110
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-9541
Practice Address - Country:US
Practice Address - Phone:303-963-1500
Practice Address - Fax:303-963-1547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO160461261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO55538339Medicaid
COCA61058Medicare PIN