Basic Information
Provider Information | |||||||||
NPI: | 1548210933 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | FROC, PC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | FRONT RANGE ORTHOPEDIC CENTER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1610 DRY CREEK DR | ||||||||
Address2: | SUITE 200 | ||||||||
City: | LONGMONT | ||||||||
State: | CO | ||||||||
PostalCode: | 805036405 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3037721600 | ||||||||
FaxNumber: | 3037729317 | ||||||||
Practice Location | |||||||||
Address1: | 1610 DRY CREEK DR | ||||||||
Address2: | SUITE 200 | ||||||||
City: | LONGMONT | ||||||||
State: | CO | ||||||||
PostalCode: | 80503 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3037721600 | ||||||||
FaxNumber: | 3037729317 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/10/2006 | ||||||||
LastUpdateDate: | 05/16/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | PATER | ||||||||
AuthorizedOfficialFirstName: | TIMOTHY | ||||||||
AuthorizedOfficialMiddleName: | J | ||||||||
AuthorizedOfficialTitleorPosition: | PRESIDENT/SECRETARY | ||||||||
AuthorizedOfficialTelephone: | 3037721600 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: | MD | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X |   |   | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |   |
ID Information
ID | Type | State | Issuer | Description | 9000153895 | 05 | CO |   | MEDICAID |