Provider Demographics
NPI:1922695410
Name:RESTORE OSTEO OF COLORADO LLC
Entity Type:Organization
Organization Name:RESTORE OSTEO OF COLORADO LLC
Other - Org Name:RESTORE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRIEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-729-2727
Mailing Address - Street 1:9195 GRANT ST STE 305
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4386
Mailing Address - Country:US
Mailing Address - Phone:207-678-9868
Mailing Address - Fax:207-678-9860
Practice Address - Street 1:9195 GRANT ST STE 305
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4386
Practice Address - Country:US
Practice Address - Phone:303-216-2661
Practice Address - Fax:303-985-3917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-30
Last Update Date:2022-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic FitterGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000191328Medicaid