Provider Demographics
NPI:1376711135
Name:ORTHOPAEDIC ASSOCIATES OF ASPEN AND GLENWOOD
Entity Type:Organization
Organization Name:ORTHOPAEDIC ASSOCIATES OF ASPEN AND GLENWOOD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECITOVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:P
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-300-9678
Mailing Address - Street 1:1450 E VALLEY RD
Mailing Address - Street 2:STE 201
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-8304
Mailing Address - Country:US
Mailing Address - Phone:970-927-8611
Mailing Address - Fax:970-927-8633
Practice Address - Street 1:1450 E VALLEY RD
Practice Address - Street 2:STE 201
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-8304
Practice Address - Country:US
Practice Address - Phone:970-927-8611
Practice Address - Fax:970-927-8633
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOPAEDIC ASSOCAITES OF ASPEN AND GLENWOOD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-14
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04007282Medicaid
CO04007282Medicaid
0730170003Medicare NSC