Provider Demographics
NPI:1962609560
Name:FRONT RANGE ENDOSCOPY CENTERS, LLC
Entity type:Organization
Organization Name:FRONT RANGE ENDOSCOPY CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BHAKTASHARAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-433-7224
Mailing Address - Street 1:2920 N CASCADE AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6265
Mailing Address - Country:US
Mailing Address - Phone:719-636-1201
Mailing Address - Fax:719-955-0986
Practice Address - Street 1:719 N CASCADE AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3205
Practice Address - Country:US
Practice Address - Phone:719-433-7224
Practice Address - Fax:719-433-7225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2019-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16C871261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO48781339Medicaid
COC809932Medicare UPIN