Provider Demographics
NPI:1750460473
Name:LOVELAND SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:LOVELAND SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BLOMQUIST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-669-3212
Mailing Address - Street 1:1900 BOISE AVE
Mailing Address - Street 2:#420
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-5004
Mailing Address - Country:US
Mailing Address - Phone:970-669-3212
Mailing Address - Fax:970-669-6162
Practice Address - Street 1:1900 BOISE AVE
Practice Address - Street 2:#420
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-5004
Practice Address - Country:US
Practice Address - Phone:970-669-3212
Practice Address - Fax:970-669-6162
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04011326Medicaid
COL1808Medicare ID - Type UnspecifiedGROUP #