Provider Demographics
NPI:1649310111
Name:CROWN POINT SURGERY CENTER, LLC
Entity type:Organization
Organization Name:CROWN POINT SURGERY CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-343-0832
Mailing Address - Street 1:9397 CROWN CREST BLVD
Mailing Address - Street 2:STE 110
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8575
Mailing Address - Country:US
Mailing Address - Phone:720-974-6499
Mailing Address - Fax:720-974-6498
Practice Address - Street 1:9397 CROWN CREST BLVD
Practice Address - Street 2:STE 110
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8575
Practice Address - Country:US
Practice Address - Phone:720-974-6499
Practice Address - Fax:720-974-6498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0039261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO99636247Medicaid
CO99636247Medicaid
COC548898Medicare PIN