Provider Demographics
NPI:1073613162
Name:ROCKY MOUNTAIN SURGERY CENTER LLC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:SWINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-789-2877
Mailing Address - Street 1:401 W HAMPDEN PL
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-2470
Mailing Address - Country:US
Mailing Address - Phone:303-789-4000
Mailing Address - Fax:303-789-5263
Practice Address - Street 1:401 W HAMPDEN PL
Practice Address - Street 2:SUITE 100
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80110-2470
Practice Address - Country:US
Practice Address - Phone:303-789-4000
Practice Address - Fax:303-789-5263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-25
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0943261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC800924Medicare ID - Type Unspecified