Provider Demographics
NPI:1235358342
Name:NORTHERN COLORADO ORTHOPEDIC ASSOCIATES
Entity Type:Organization
Organization Name:NORTHERN COLORADO ORTHOPEDIC ASSOCIATES
Other - Org Name:NORTHERN COLORADO ORTHOPEDIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KNAUER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-224-9890
Mailing Address - Street 1:2121 E. HARMONY RD.
Mailing Address - Street 2:STE 290
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528
Mailing Address - Country:US
Mailing Address - Phone:970-224-9890
Mailing Address - Fax:970-224-9800
Practice Address - Street 1:2121 E. HARMONY RD.
Practice Address - Street 2:STE 290
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80528
Practice Address - Country:US
Practice Address - Phone:970-224-9890
Practice Address - Fax:970-224-9800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04009221Medicaid
CO04009221Medicaid