Provider Demographics
NPI:1750074233
Name:LUCKY BREAK ORTHOPEDICS, PC
Entity type:Organization
Organization Name:LUCKY BREAK ORTHOPEDICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
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:PO BOX 1627
Mailing Address - Street 2:
Mailing Address - City:CRESTED BUTTE
Mailing Address - State:CO
Mailing Address - Zip Code:81224-1627
Mailing Address - Country:US
Mailing Address - Phone:970-672-1980
Mailing Address - Fax:970-817-2112
Practice Address - Street 1:510 ELK AVE STE 2
Practice Address - Street 2:
Practice Address - City:CRESTED BUTTE
Practice Address - State:CO
Practice Address - Zip Code:81224-5433
Practice Address - Country:US
Practice Address - Phone:970-672-1980
Practice Address - Fax:970-817-2112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-31
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty