Provider Demographics
NPI:1275526378
Name:DRY CREEK SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:DRY CREEK SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUISNESS MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:KOHLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-895-6803
Mailing Address - Street 1:135 INVERNESS DR E
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-5115
Mailing Address - Country:US
Mailing Address - Phone:303-706-9001
Mailing Address - Fax:303-706-9002
Practice Address - Street 1:135 INVERNESS DR E
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-5115
Practice Address - Country:US
Practice Address - Phone:303-706-9001
Practice Address - Fax:303-706-9002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0216261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO18526268Medicaid
CO18526268Medicaid