Provider Demographics
NPI:1013059732
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:MS
Authorized Official - First Name:KIMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:BREKKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:307-778-6595
Mailing Address - Street 1:2110 EVANS AVE
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-3734
Mailing Address - Country:US
Mailing Address - Phone:307-778-6595
Mailing Address - Fax:307-778-6191
Practice Address - Street 1:2110 EVANS AVE
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-3734
Practice Address - Country:US
Practice Address - Phone:307-778-6595
Practice Address - Fax:307-778-6191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
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
WY117954300Medicaid
CO97021032Medicaid
WY117954300Medicaid
CO4097670003Medicare NSC