Provider Demographics
NPI:1477576890
Name:STEAMBOAT ORTHOPAEDIC ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:STEAMBOAT ORTHOPAEDIC ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:MOSELEY
Authorized Official - Last Name:WALTON
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:970-879-4612
Mailing Address - Street 1:940 CENTRAL PARK DR #190
Mailing Address - Street 2:
Mailing Address - City:STEAMBOAT SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80487-8816
Mailing Address - Country:US
Mailing Address - Phone:970-879-4612
Mailing Address - Fax:970-879-0583
Practice Address - Street 1:940 CENTRAL PARK DR #190
Practice Address - Street 2:
Practice Address - City:STEAMBOAT SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80487-8816
Practice Address - Country:US
Practice Address - Phone:970-879-4612
Practice Address - Fax:970-879-0583
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO174400000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04006383Medicaid
COST95908OtherCO BCBS
CO0470600001Medicare NSC
COCS0314Medicare PIN
CO04006383Medicaid