Basic Information
| Provider Information | |||||||||
| NPI: | 1477516961 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRUM SURGERY CENTER LTD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8200 E BELLEVIEW AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801112803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032900600 | ||||||||
| FaxNumber: | 3032906359 | ||||||||
| Practice Location | |||||||||
| Address1: | 8200 E BELLEVIEW AVE STE 300 | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD VILLAGE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801112826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032900600 | ||||||||
| FaxNumber: | 3032906359 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/07/2006 | ||||||||
| LastUpdateDate: | 04/05/2018 | ||||||||
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| AuthorizedOfficialLastName: | SWINNEY | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | GREGORY | ||||||||
| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 9727892877 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 0707 | CO | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 04510285 | 05 | CO | MEDICAID |