Provider Demographics
NPI:1548210933
Name:FROC, PC
Entity Type:Organization
Organization Name:FROC, PC
Other - Org Name:FRONT RANGE ORTHOPEDIC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:PATER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-772-1600
Mailing Address - Street 1:1610 DRY CREEK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-6405
Mailing Address - Country:US
Mailing Address - Phone:303-772-1600
Mailing Address - Fax:303-772-9317
Practice Address - Street 1:1610 DRY CREEK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80503
Practice Address - Country:US
Practice Address - Phone:303-772-1600
Practice Address - Fax:303-772-9317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2018-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000153895Medicaid
COC369108Medicare ID - Type UnspecifiedGROUP NUMBER