Provider Demographics
NPI:1689889966
Name:ORTHOPEDIC SURGERY & SPORTS MEDICINE SPECIALIST
Entity Type:Organization
Organization Name:ORTHOPEDIC SURGERY & SPORTS MEDICINE SPECIALIST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:JOEL
Authorized Official - Last Name:WINTORY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-450-6800
Mailing Address - Street 1:9141 GRANT ST # 10
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4374
Mailing Address - Country:US
Mailing Address - Phone:303-450-6800
Mailing Address - Fax:303-450-7153
Practice Address - Street 1:9141 GRANT ST STE 10
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4374
Practice Address - Country:US
Practice Address - Phone:303-450-6800
Practice Address - Fax:303-450-7153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COORB9208OtherBLUE CROSS BLUE SHEILD
CO04111324Medicaid
COCV0100OtherMEDICARE RAILROAD
COCB9208Medicare PIN