Provider Demographics
NPI: | 1669111498 |
---|---|
Name: | ORTHOPAEDICS OF STEAMBOAT SPRINGS PC |
Entity type: | Organization |
Organization Name: | ORTHOPAEDICS OF STEAMBOAT SPRINGS PC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | FINANCE DIRECTOR |
Authorized Official - Prefix: | |
Authorized Official - First Name: | LISA |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | HOGUE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 970-879-6663 |
Mailing Address - Street 1: | 705 MARKETPLACE PLZ STE 200 |
Mailing Address - Street 2: | |
Mailing Address - City: | STEAMBOAT SPRINGS |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 80487-1841 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 970-879-6663 |
Mailing Address - Fax: | 970-871-1234 |
Practice Address - Street 1: | 17230 JACKSON CREEK PKWY STE 260 |
Practice Address - Street 2: | |
Practice Address - City: | MONUMENT |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80132-7305 |
Practice Address - Country: | US |
Practice Address - Phone: | 719-301-3010 |
Practice Address - Fax: | 970-871-1234 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2022-05-31 |
Last Update Date: | 2022-05-31 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty |