Provider Demographics
NPI:1861663098
Name:ASCENT SURGERY CENTER, LLC
Entity type:Organization
Organization Name:ASCENT SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:LIEBSCHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-598-7192
Mailing Address - Street 1:5901 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-1941
Mailing Address - Country:US
Mailing Address - Phone:719-598-7192
Mailing Address - Fax:719-634-2686
Practice Address - Street 1:5901 CORPORATE DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919-1941
Practice Address - Country:US
Practice Address - Phone:719-598-7192
Practice Address - Fax:719-634-2686
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-15
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOB4457Medicare PIN