Provider Demographics
NPI:1194723981
Name:GREENWOOD ASC LLC
Entity type:Organization
Organization Name:GREENWOOD ASC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICER, AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:DANNA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3890
Mailing Address - Street 1:7447 E BERRY AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2146
Mailing Address - Country:US
Mailing Address - Phone:720-493-4100
Mailing Address - Fax:303-221-4430
Practice Address - Street 1:7447 E BERRY AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2146
Practice Address - Country:US
Practice Address - Phone:720-493-4100
Practice Address - Fax:303-221-4430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-14
Last Update Date:2021-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0422261QA1903X
CO16K557261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO06C0001133Medicare Oscar/Certification
COCOB5177Medicare PIN