Provider Demographics
NPI:1437145794
Name:ORTHOPAEDIC & SPINE CENTER OF THE ROCKIES PC
Entity Type:Organization
Organization Name:ORTHOPAEDIC & SPINE CENTER OF THE ROCKIES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-419-7005
Mailing Address - Street 1:2500 E PROSPECT RD
Mailing Address - Street 2:AMBULATORY SURGERY CENTER & CONVALESCENT CARE CENTER
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-9718
Mailing Address - Country:US
Mailing Address - Phone:970-493-0112
Mailing Address - Fax:
Practice Address - Street 1:2500 E PROSPECT RD
Practice Address - Street 2:AMBULATORY SURGERY CENTER & CONVALESCENT CARE CENTER
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-9718
Practice Address - Country:US
Practice Address - Phone:970-493-0112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-22
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO160343261QA1903X, 261QE0800X, 261QP3300X
261QM1300X, 261QP1100X, 261QR0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
No261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QR0800XAmbulatory Health Care FacilitiesClinic/CenterRecovery Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04510152Medicaid
WY107463600Medicaid
COCA61022Medicare PIN