Provider Demographics
NPI:1972691400
Name:VAIL-SUMMIT ORTHOPAEDICS PC
Entity Type:Organization
Organization Name:VAIL-SUMMIT ORTHOPAEDICS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:KINLUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-477-4456
Mailing Address - Street 1:2472 PATTERSON ROAD
Mailing Address - Street 2:UNIT 8
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81505-1100
Mailing Address - Country:US
Mailing Address - Phone:970-241-0202
Mailing Address - Fax:970-245-0250
Practice Address - Street 1:360 PEAK ONE DRIVE
Practice Address - Street 2:SUITE 180
Practice Address - City:FRISCO
Practice Address - State:CO
Practice Address - Zip Code:80443-9998
Practice Address - Country:US
Practice Address - Phone:970-668-3633
Practice Address - Fax:970-668-4406
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VAIL-SUMMIT ORTHOPAEDICS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-10
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO24770710Medicaid
CO24770710Medicaid
CO465498Medicare ID - Type UnspecifiedMEDICARE GROUP BILING NUM
C465498Medicare UPIN