Provider Demographics
NPI:1932394269
Name:NORTHEAST COLORADO ORTHOPEDIC SURGERY
Entity Type:Organization
Organization Name:NORTHEAST COLORADO ORTHOPEDIC SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARREL
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:FENTON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:970-522-2264
Mailing Address - Street 1:1405 S 8TH AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-4563
Mailing Address - Country:US
Mailing Address - Phone:970-522-2264
Mailing Address - Fax:970-522-2272
Practice Address - Street 1:1405 S 8TH AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-4563
Practice Address - Country:US
Practice Address - Phone:970-522-2264
Practice Address - Fax:970-522-2272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04006565Medicaid
CO04006565Medicaid