Basic Information
| Provider Information | |||||||||
| NPI: | 1275708919 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOMEN'S SURGICAL CENTER AT NORTHCARE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5390 N ACADEMY BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809184065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195966110 | ||||||||
| FaxNumber: | 7195976112 | ||||||||
| Practice Location | |||||||||
| Address1: | 6071 E WOODMEN RD | ||||||||
| Address2: | STE 425 | ||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7198677500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2008 | ||||||||
| LastUpdateDate: | 04/24/2008 | ||||||||
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| AuthorizedOfficialLastName: | ASHBY | ||||||||
| AuthorizedOfficialFirstName: | BRENT | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 7198677500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.