Provider Demographics
NPI:1497735559
Name:COLORADO ENDOSCOPY CENTERS, LLC
Entity Type:Organization
Organization Name:COLORADO ENDOSCOPY CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-532-2986
Mailing Address - Street 1:205 S MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-1716
Mailing Address - Country:US
Mailing Address - Phone:303-532-2986
Mailing Address - Fax:303-776-4318
Practice Address - Street 1:205 S MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-1716
Practice Address - Country:US
Practice Address - Phone:303-532-2986
Practice Address - Fax:303-776-4318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16N612261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC800663Medicare UPIN