Basic Information
| Provider Information | |||||||||
| NPI: | 1073189312 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PANORAMA ORTHOPEDICS & SPINE CENTER, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 660 GOLDEN RIDGE RD STE 250 | ||||||||
| Address2: | |||||||||
| City: | GOLDEN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804019541 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032331223 | ||||||||
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| Practice Location | |||||||||
| Address1: | 15000 W 6TH AVE UNIT 106-B | ||||||||
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| City: | GOLDEN | ||||||||
| State: | CO | ||||||||
| PostalCode: | 804016586 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7205416817 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2021 | ||||||||
| LastUpdateDate: | 05/27/2021 | ||||||||
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| AuthorizedOfficialLastName: | CONKLIN | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3032747321 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PANORAMA ORTHOPEDICS & SPINE CENTER, PC | ||||||||
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| NPICertificationDate: | 05/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QP2000X | Y | Ambulatory Health Care Facilities | Clinic/Center | Physical Therapy |
No ID Information.