Healthcare Provider Details

I. General information

NPI: 1376711135
Provider Name (Legal Business Name): ORTHOPAEDIC ASSOCIATES OF ASPEN AND GLENWOOD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2008
Last Update Date: 03/16/2020
Certification Date: 03/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 E VALLEY RD STE 201
BASALT CO
81621-8304
US

IV. Provider business mailing address

1450 E VALLEY RD STE 201
BASALT CO
81621-8304
US

V. Phone/Fax

Practice location:
  • Phone: 970-927-8611
  • Fax: 970-927-8633
Mailing address:
  • Phone: 970-927-8611
  • Fax: 970-927-8633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY P. BURNS
Title or Position: EXECITOVE DIRECTOR
Credential:
Phone: 970-300-9678