Provider Demographics
NPI:1063595221
Name:SURGERY CENTER OF LOVELAND, LLC
Entity type:Organization
Organization Name:SURGERY CENTER OF LOVELAND, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SONIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:FOOTE
Authorized Official - Suffix:
Authorized Official - Credentials:BSN RN
Authorized Official - Phone:970-622-0608
Mailing Address - Street 1:3800 GRANT AVE
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8412
Mailing Address - Country:US
Mailing Address - Phone:970-622-0608
Mailing Address - Fax:970-622-0610
Practice Address - Street 1:3800 GRANT AVE
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8412
Practice Address - Country:US
Practice Address - Phone:970-622-0608
Practice Address - Fax:970-622-0610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-23
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1198261QR0800X
CO1180261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO56222025Medicaid
COC499248Medicare PIN