Provider Demographics
NPI:1598151078
Name:FORT COLLINS ORTHOPAEDICS LLC
Entity Type:Organization
Organization Name:FORT COLLINS ORTHOPAEDICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-222-9745
Mailing Address - Street 1:5491 TRADE WIND DR
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80528-7509
Mailing Address - Country:US
Mailing Address - Phone:303-548-9475
Mailing Address - Fax:
Practice Address - Street 1:5491 TRADE WIND DR
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80528-7509
Practice Address - Country:US
Practice Address - Phone:303-548-9475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FORT COLLINS ORTHOPAEDICS LLC DME
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-10
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies