Provider Demographics
NPI:1508940925
Name:HIGH COUNTRY ORTHOPAEDICS & SPORTS PC
Entity Type:Organization
Organization Name:HIGH COUNTRY ORTHOPAEDICS & SPORTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:B
Authorized Official - Last Name:HUENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-874-4399
Mailing Address - Street 1:PO BOX 1129
Mailing Address - Street 2:
Mailing Address - City:DELTA
Mailing Address - State:CO
Mailing Address - Zip Code:81416-1129
Mailing Address - Country:US
Mailing Address - Phone:970-874-2470
Mailing Address - Fax:970-874-2475
Practice Address - Street 1:296 STAFFORD LN
Practice Address - Street 2:
Practice Address - City:DELTA
Practice Address - State:CO
Practice Address - Zip Code:81416-2273
Practice Address - Country:US
Practice Address - Phone:970-874-4399
Practice Address - Fax:970-874-7558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33382207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07506741Medicaid
CO186893800OtherOWCP
COHIA46293OtherBCBS
COHIA46293OtherBCBS
F86560Medicare UPIN
CO186893800OtherOWCP
CODB9807Medicare PIN