Provider Demographics
NPI:1144402058
Name:JENNIFER FORREST ORTHOPAEDICS, INC.
Entity Type:Organization
Organization Name:JENNIFER FORREST ORTHOPAEDICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:CASSIDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-259-3020
Mailing Address - Street 1:575 RIVERGATE LANE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301-7487
Mailing Address - Country:US
Mailing Address - Phone:970-259-3020
Mailing Address - Fax:970-259-9766
Practice Address - Street 1:575 RIVERGATE LANE
Practice Address - Street 2:SUITE 105
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-7487
Practice Address - Country:US
Practice Address - Phone:970-259-3020
Practice Address - Fax:970-259-9766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41436174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO510388Medicare PIN
COH94530Medicare UPIN