Provider Demographics
NPI:1033303797
Name:NORTHERN COLORADO HAND & WRIST CENTER PC
Entity Type:Organization
Organization Name:NORTHERN COLORADO HAND & WRIST CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:MAHON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-221-2827
Mailing Address - Street 1:1175 58TH AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-4807
Mailing Address - Country:US
Mailing Address - Phone:970-495-0300
Mailing Address - Fax:970-224-9624
Practice Address - Street 1:2121 E HARMONY RD
Practice Address - Street 2:UNIT 260
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528-3402
Practice Address - Country:US
Practice Address - Phone:970-221-2827
Practice Address - Fax:970-221-2854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01038212A207XS0106X
CO46063207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NON46063OtherANTHEM BCBS
CO46207759Medicaid
NON46063OtherANTHEM BCBS
COC810568Medicare PIN