Provider Demographics
NPI:1326167503
Name:WEST DENVER ASC, LLC
Entity Type:Organization
Organization Name:WEST DENVER ASC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JONI
Authorized Official - Middle Name:G
Authorized Official - Last Name:HYRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-432-8777
Mailing Address - Street 1:10050 W 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4157
Mailing Address - Country:US
Mailing Address - Phone:303-432-8777
Mailing Address - Fax:303-432-8778
Practice Address - Street 1:10050 W 41ST AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4157
Practice Address - Country:US
Practice Address - Phone:303-432-8777
Practice Address - Fax:303-432-8778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0073261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO62335Medicare UPIN
CO440358Medicare ID - Type UnspecifiedMEDICARE