Provider Demographics
NPI:1124025424
Name:ORTHOPAEDICS OF STEAMBOAT SPRINGS
Entity Type:Organization
Organization Name:ORTHOPAEDICS OF STEAMBOAT SPRINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:HOGUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-879-6663
Mailing Address - Street 1:705 MARKETPLACE PLZ STE 200
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-1841
Mailing Address - Country:US
Mailing Address - Phone:970-879-6663
Mailing Address - Fax:970-871-1234
Practice Address - Street 1:705 MARKETPLACE PLZ
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-1838
Practice Address - Country:US
Practice Address - Phone:970-879-6663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO36904872Medicaid
CO36904872Medicaid