MEDICARE: ROCKY MOUNTAIN ORTHOPEDIC SPECIALISTS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XS0117X	Orthopaedic Surgery of the Spine Physician	41285	CO

General Provider Information

NPI Number	:	1699070193
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKY MOUNTAIN ORTHOPEDIC SPECIALISTS

Provider Business Mailing Address
First Line	:	800 E 20TH ST STE 300
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82001-3882
Country	:	US
Telephone Number	:	307-632-6637
Fax Number	:	307-632-3382

Provider Business Practice Location Address
First Line	:	5285 MCWHINNEY BLVD STE 140
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-8707
Country	:	US
Telephone Number	:	888-876-2663
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	W. CARLTON RECKLING
Credential	:	M.D.
Telephone Number	:	307-632-6637

Provider Enumeration Date	:	01/14/2011
Last Update Date	:	01/14/2011

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