Basic Information
| Provider Information | |||||||||
| NPI: | 1568426872 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLORADO ORTHOPEDIC CONSULTANTS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1411 SO POTOMAC ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036956060 | ||||||||
| FaxNumber: | 3033697776 | ||||||||
| Practice Location | |||||||||
| Address1: | 1411 SO POTOMAC ST | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80012 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036956060 | ||||||||
| FaxNumber: | 3033697776 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2006 | ||||||||
| LastUpdateDate: | 07/08/2013 | ||||||||
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| AuthorizedOfficialLastName: | DAVIS | ||||||||
| AuthorizedOfficialFirstName: | CRAIG | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3036956060 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 00043887 | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 04004404 | 05 | CO | MEDICAID |