Basic Information
| Provider Information | |||||||||
| NPI: | 1508940925 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HIGH COUNTRY ORTHOPAEDICS & SPORTS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1129 | ||||||||
| Address2: | |||||||||
| City: | DELTA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814161129 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708742470 | ||||||||
| FaxNumber: | 9708742475 | ||||||||
| Practice Location | |||||||||
| Address1: | 296 STAFFORD LN | ||||||||
| Address2: | |||||||||
| City: | DELTA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 814162273 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9708744399 | ||||||||
| FaxNumber: | 9708747558 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/24/2006 | ||||||||
| LastUpdateDate: | 07/16/2013 | ||||||||
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| AuthorizedOfficialLastName: | HUENE | ||||||||
| AuthorizedOfficialFirstName: | DOUGLAS | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9708744399 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 33382 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 07506741 | 05 | CO | MEDICAID | 186893800 | 01 | CO | OWCP | OTHER | HIA46293 | 01 | CO | BCBS | OTHER |