1932394269 NPI number — NORTHEAST COLORADO ORTHOPEDIC SURGERY

Table of content: (NPI 1932394269)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932394269 NPI number — NORTHEAST COLORADO ORTHOPEDIC SURGERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHEAST COLORADO ORTHOPEDIC SURGERY
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:
Provider Other Organization Name Type Code:
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:
1932394269
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1405 S 8TH AVE
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
STERLING
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80751-4563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-522-2264
Provider Business Mailing Address Fax Number:
970-522-2272

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1405 S 8TH AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
STERLING
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80751-4563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-522-2264
Provider Business Practice Location Address Fax Number:
970-522-2272
Provider Enumeration Date:
09/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FENTON
Authorized Official First Name:
DARREL
Authorized Official Middle Name:
THOMAS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
970-522-2264

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 04006565 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com