Organization
BLACK CANYON SURGICAL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN PHILLIP HARPER (ADMINISTRATOR)
(970) 249-6842
Entity
Organization
Contact information
Practice address
611 E. STAR CT., SUITE C, MONTROSE, CO 81401-6701
(970) 249-6842
(970) 249-6942
Mailing address
611 E. STAR CT., SUITE C, MONTROSE, CO 81401-6701
(970) 249-6842
(970) 249-6942
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
0539
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
67515 BL
ANTHEM BLUE CROSS BLUE SH
CO
05
—
75038358
—
CO
01
—
P00307659
PALMETTO RAILROAD MEDICAR
GA
Enumeration date
05/17/2006
Last updated
04/20/2008
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