Organization
ST. VRAIN ENDOSCOPY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. PETER S. KAYE M.D., F.A.C.G. (MANAGING PARTNER)
(720) 932-7713
Entity
Organization
Contact information
Practice address
1551 PROFESSIONAL LN, SUITE 295, LONGMONT, CO 80501-6972
(303) 702-5900
(720) 890-0502
Mailing address
382 S ARTHUR AVE, LOUISVILLE, CO 80027-3094
(720) 932-7713
(720) 890-0502
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
162
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08677344
—
CO
01
—
P00128204
RAILROAD MEDICARE
CO
01
—
ST66577
BCBS
CO
Enumeration date
06/25/2006
Last updated
05/16/2008
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