Provider Demographics
NPI:1689649451
Name:THE SURGERY CENTER AT PARK MEADOWS, L.L.C.
Entity Type:Organization
Organization Name:THE SURGERY CENTER AT PARK MEADOWS, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCNALLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-799-6465
Mailing Address - Street 1:9218 KIMMER DR
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-6733
Mailing Address - Country:US
Mailing Address - Phone:303-799-6465
Mailing Address - Fax:303-799-0556
Practice Address - Street 1:9218 KIMMER DR
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-6732
Practice Address - Country:US
Practice Address - Phone:303-799-6465
Practice Address - Fax:303-799-0556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0279261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO668152OtherANTHEM BLUE CROSS
CO50837737Medicaid
COC530598Medicare ID - Type Unspecified