Provider Demographics
NPI:1346308954
Name:DAY SURGERY OF GRAND JUNCTION LLC
Entity Type:Organization
Organization Name:DAY SURGERY OF GRAND JUNCTION LLC
Other - Org Name:DAY SURGERY OF GRAND JUNCTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ELLISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-273-7449
Mailing Address - Street 1:3900 E MEXICO AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80210-3941
Mailing Address - Country:US
Mailing Address - Phone:303-800-2078
Mailing Address - Fax:303-800-2078
Practice Address - Street 1:1000 WELLINGTON AVE
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-8180
Practice Address - Country:US
Practice Address - Phone:970-245-5989
Practice Address - Fax:970-243-9023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0526261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04510145Medicaid
CO=========Medicaid
=========005OtherUT MEDICAID
=========005OtherUT MEDICAID
COCA61019Medicare PIN