Basic Information
| Provider Information | |||||||||
| NPI: | 1962460204 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DENVER-VAIL ORTHOPEDICS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8101 E LOWRY BLVD | ||||||||
| Address2: | SUITE 260 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802307196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032144500 | ||||||||
| FaxNumber: | 3032144571 | ||||||||
| Practice Location | |||||||||
| Address1: | 8101 E LOWRY BLVD | ||||||||
| Address2: | SUITE 260 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802307196 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3032144500 | ||||||||
| FaxNumber: | 3032144571 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/03/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HESS | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3032144500 | ||||||||
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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 | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 04257227 | 05 | CO | MEDICAID |