Provider Demographics
NPI:1942540851
Name:THE ORTHOPAEDIC AND SPINE CENTER OF SOUTHERN COLORADO, LLC
Entity Type:Organization
Organization Name:THE ORTHOPAEDIC AND SPINE CENTER OF SOUTHERN COLORADO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-287-5362
Mailing Address - Street 1:1658 COLE BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3304
Mailing Address - Country:US
Mailing Address - Phone:720-287-5362
Mailing Address - Fax:
Practice Address - Street 1:4110 BRIARGATE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7835
Practice Address - Country:US
Practice Address - Phone:720-287-5362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-01
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical