Provider Demographics
NPI:1992835318
Name:QUORUM ORTHOPEDICS, INC
Entity Type:Organization
Organization Name:QUORUM ORTHOPEDICS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:BREKKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-686-2266
Mailing Address - Street 1:561 E GARDEN DR UNIT H
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-3149
Mailing Address - Country:US
Mailing Address - Phone:970-686-2266
Mailing Address - Fax:970-686-8823
Practice Address - Street 1:561 E GARDEN DR
Practice Address - Street 2:STE H
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-3148
Practice Address - Country:US
Practice Address - Phone:970-686-2266
Practice Address - Fax:970-686-8823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCP003160335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO97021032Medicaid
WY117954300Medicaid
CO4097670003Medicare NSC
CO97021032Medicaid