Provider Demographics
NPI:1922738228
Name:ORTHOPEDIC PROFESSIONAL ASSOCIATION P.C.
Entity Type:Organization
Organization Name:ORTHOPEDIC PROFESSIONAL ASSOCIATION P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:R
Authorized Official - Last Name:GAGLIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-665-0286
Mailing Address - Street 1:4820 RIVERBEND RD STE 200
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2618
Mailing Address - Country:US
Mailing Address - Phone:303-665-0286
Mailing Address - Fax:
Practice Address - Street 1:1032 S 88TH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9452
Practice Address - Country:US
Practice Address - Phone:303-665-0286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ORTHOPEDIC PROFESSIONAL ASSOCIATION P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-06-10
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04006649Medicaid