# NORTHWEST REGIONAL ASC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Northwest Regional Ambulatory Surgery Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851399646
- **Authorized official:** JENETHA D MORAN (OFFICER/AUTHORIZED OFFICIAL)
- **Authorized official phone:** (972) 763-3893

## Contact information

- **Practice address:** 10170 CHURCH RANCH WAY, STE 110, WESTMINSTER, CO 80021-6058
- **Practice address phone:** (303) 328-3400
- **Practice address fax:** (303) 328-3401
- **Mailing address:** 10170 CHURCH RANCH WAY, STE 110, WESTMINSTER, CO 80021-6058
- **Mailing address phone:** (303) 328-3400
- **Mailing address fax:** (303) 328-3401

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 16P689 | CO | Yes |

## Other

- **Enumeration date:** 07/14/2005
- **Last updated:** 12/03/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 72636076 | — | CO |
| 01 | — | P00228297 | RAILROAD MEDICARE | CO |