Provider Demographics
NPI:1124086608
Name:LUTHERAN CAMPUS ASC LLC
Entity type:Organization
Organization Name:LUTHERAN CAMPUS ASC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:DECKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-301-7705
Mailing Address - Street 1:12905 W 40TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-2791
Mailing Address - Country:US
Mailing Address - Phone:303-301-7700
Mailing Address - Fax:303-301-7701
Practice Address - Street 1:12905 W 40TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-2791
Practice Address - Country:US
Practice Address - Phone:303-301-7700
Practice Address - Fax:303-301-7701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical