Provider Demographics
NPI:1386795540
Name:THE SURGERY CENTER AT LONE TREE, LLC
Entity type:Organization
Organization Name:THE SURGERY CENTER AT LONE TREE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:PERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HANEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-367-2225
Mailing Address - Street 1:8500 PARK MEADOWS DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124
Mailing Address - Country:US
Mailing Address - Phone:303-951-7510
Mailing Address - Fax:303-951-7511
Practice Address - Street 1:8500 PARK MEADOWS DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124
Practice Address - Country:US
Practice Address - Phone:303-951-7510
Practice Address - Fax:303-951-7511
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPINE ONE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-15
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COB4070OtherMEDICARE PTAN
CO32744OtherSTATE LICENSE NUMBER
COB4070OtherMEDICARE PTAN
COB4070Medicare UPIN
06C0001121Medicare Oscar/Certification