Basic Information
| Provider Information | |||||||||
| NPI: | 1548738495 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OCR LOVELAND ASC & CCC LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3470 E 15TH ST | ||||||||
| Address2: | |||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805388809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706633975 | ||||||||
| FaxNumber: | 9704930521 | ||||||||
| Practice Location | |||||||||
| Address1: | 3470 E 15TH ST | ||||||||
| Address2: | |||||||||
| City: | LOVELAND | ||||||||
| State: | CO | ||||||||
| PostalCode: | 805388809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9706633975 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/08/2018 | ||||||||
| LastUpdateDate: | 10/26/2022 | ||||||||
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| AuthorizedOfficialLastName: | BERGERSON | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9704197115 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 10/26/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0800X | N | Ambulatory Health Care Facilities | Clinic/Center | Endoscopy | 261QP1100X | N | Ambulatory Health Care Facilities | Clinic/Center | Podiatric | 261QP3300X | N | Ambulatory Health Care Facilities | Clinic/Center | Pain | 261QR0800X | N | Ambulatory Health Care Facilities | Clinic/Center | Recovery Care | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.