| Organization Name: | MIDVALLEY AMBULATORY SURGERY CENTER LLC |
| NPI Number: | 1376507780 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MARK I. PURNELL (MEDICAL DIRECTOR) |
| Mailing Address: | 1450 E Valley Rd Suite 202 Basalt |
| State: | CO US |
| Postal Code: | 816218304 |
| Phone Number: | 9705441360 |
| Fax Number: | 9705441387 |
| NPI Enumeration Date: | 04/13/2006 |
| NPI Last Update Date: | 10/06/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QA1903X |
| License Number: | 0563 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CO |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Ambulatory Surgical |
| Taxonomy Definition: | |