Provider Demographics
NPI:1780683797
Name:LOVELAND ENDOSCOPY CENTER, LLC
Entity Type:Organization
Organization Name:LOVELAND ENDOSCOPY CENTER, LLC
Other - Org Name:SKYLINE ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:
Authorized Official - Last Name:STRONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-669-5432
Mailing Address - Street 1:PO BOX 1524
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80539-1524
Mailing Address - Country:US
Mailing Address - Phone:970-663-2159
Mailing Address - Fax:970-461-6260
Practice Address - Street 1:2555 E 13TH ST
Practice Address - Street 2:SUITE #210
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-5113
Practice Address - Country:US
Practice Address - Phone:970-663-2159
Practice Address - Fax:970-461-6260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0591261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO10656243Medicaid
CO800854Medicare ID - Type Unspecified