1235735754 NPI number — ORTHOPAEDIC & SPINE CENTER OF THE ROCKIES PC

Table of content: (NPI 1235735754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235735754 NPI number — ORTHOPAEDIC & SPINE CENTER OF THE ROCKIES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOPAEDIC & SPINE CENTER OF THE ROCKIES PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ORTHOPAEDIC & SPINE CENTER OF THE ROCKIES - GR
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235735754
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2500 E PROSPECT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT COLLINS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80525-9718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-493-0112
Provider Business Mailing Address Fax Number:
970-493-1794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1926 61ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREELEY
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-573-3224
Provider Business Practice Location Address Fax Number:
970-493-0521
Provider Enumeration Date:
12/09/2020

Additional Information

Authorized Official

Authorized Official Last Name:
AUGUSTINE
Authorized Official First Name:
LISA
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
970-419-7018

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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