Provider Demographics
NPI:1407691439
Name:LUCKY BREAK ORTHOPEDICS PC
Entity type:Organization
Organization Name:LUCKY BREAK ORTHOPEDICS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:HENRY
Authorized Official - Last Name:ELFENBEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-672-1980
Mailing Address - Street 1:P.O. BOX 1627
Mailing Address - Street 2:
Mailing Address - City:CRESTED BUTTE
Mailing Address - State:CO
Mailing Address - Zip Code:81224
Mailing Address - Country:US
Mailing Address - Phone:970-672-1980
Mailing Address - Fax:970-817-2112
Practice Address - Street 1:711 N TAYLOR ST STE 200A
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-2220
Practice Address - Country:US
Practice Address - Phone:970-672-1980
Practice Address - Fax:970-817-2112
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LUCKY BREAK ORTHOPEDICS PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-07-01
Last Update Date:2024-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies