Provider Demographics
NPI:1508009564
Name:RENEWAL SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:RENEWAL SURGERY CENTER, LLC
Other - Org Name:YOSEMITE STREET SURGERY CENTER, LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STACY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUCHANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-475-8412
Mailing Address - Street 1:9777 S YOSEMITE ST STE 210
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-3115
Mailing Address - Country:US
Mailing Address - Phone:303-708-2943
Mailing Address - Fax:720-475-8485
Practice Address - Street 1:9777 S YOSEMITE ST STE 210
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-3115
Practice Address - Country:US
Practice Address - Phone:303-708-2943
Practice Address - Fax:720-475-8485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2017-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16E991261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical