Provider Demographics
NPI:1750386322
Name:NOVAMED SURGERY CENTER OF COLORADO SPRINGS, LLC
Entity type:Organization
Organization Name:NOVAMED SURGERY CENTER OF COLORADO SPRINGS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER AND AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:B
Authorized Official - Last Name:BALDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-234-5954
Mailing Address - Street 1:3920 N UNION BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-4920
Mailing Address - Country:US
Mailing Address - Phone:719-227-9711
Mailing Address - Fax:847-296-5990
Practice Address - Street 1:3920 N UNION BLVD STE 240
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4920
Practice Address - Country:US
Practice Address - Phone:719-227-9711
Practice Address - Fax:719-227-9725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2023-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0239261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
490005417OtherRR MEDICARE
CO75600331Medicaid
CO75600331Medicaid