Provider Demographics
NPI:1912979717
Name:ENGLEWOOD ASC LLC
Entity Type:Organization
Organization Name:ENGLEWOOD ASC LLC
Other - Org Name:SOUTH DENVER ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILLIP
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLENDENIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-665-1283
Mailing Address - Street 1:499 E HAMPDEN AVE
Mailing Address - Street 2:SUITE 430
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113-2780
Mailing Address - Country:US
Mailing Address - Phone:303-874-0350
Mailing Address - Fax:303-874-1706
Practice Address - Street 1:499 E HAMPDEN AVE
Practice Address - Street 2:SUITE 430
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113-2780
Practice Address - Country:US
Practice Address - Phone:303-874-0350
Practice Address - Fax:303-874-1706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0145261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO=========801130000OtherWPS-TRIWEST-TRICARE
CO=========801130000OtherWPS-TRIWEST-TRICARE
COCB61032Medicare PIN
CO06C0001032Medicare Oscar/Certification