Provider Demographics
NPI:1871651638
Name:SUMMIT EAGLE SPINE AND REHABILITATION PC
Entity Type:Organization
Organization Name:SUMMIT EAGLE SPINE AND REHABILITATION PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:W
Authorized Official - Last Name:COLLITON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-668-9471
Mailing Address - Street 1:PO BOX 5089
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:CO
Mailing Address - Zip Code:80443-5089
Mailing Address - Country:US
Mailing Address - Phone:970-668-9471
Mailing Address - Fax:970-668-9473
Practice Address - Street 1:360 PEAKONE DRIVE
Practice Address - Street 2:SUITE 390
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443
Practice Address - Country:US
Practice Address - Phone:970-668-9471
Practice Address - Fax:970-668-9473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33679225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC507148Medicare ID - Type UnspecifiedGROUP NUMBER