Provider Demographics
NPI:1679797732
Name:SURGICAL ASSOCIATES OF GREELEY
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES OF GREELEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:W
Authorized Official - Last Name:OGREN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-352-8216
Mailing Address - Street 1:1800 15TH ST STE 210
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80631-4563
Mailing Address - Country:US
Mailing Address - Phone:970-352-8216
Mailing Address - Fax:970-352-5297
Practice Address - Street 1:1800 15TH ST STE 210
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80631-4563
Practice Address - Country:US
Practice Address - Phone:970-352-8216
Practice Address - Fax:970-352-5297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04013207Medicaid
CO04013207Medicaid