Provider Demographics
NPI:1548738495
Name:OCR LOVELAND ASC & CCC LLC
Entity Type:Organization
Organization Name:OCR LOVELAND ASC & CCC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-419-7115
Mailing Address - Street 1:3470 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8809
Mailing Address - Country:US
Mailing Address - Phone:970-663-3975
Mailing Address - Fax:970-493-0521
Practice Address - Street 1:3470 E 15TH ST
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8809
Practice Address - Country:US
Practice Address - Phone:970-663-3975
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-08
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care