Healthcare Provider Details

I. General information

NPI: 1316636202
Provider Name (Legal Business Name): TIMOTHY ANDREW NELSON BOCO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2023
Last Update Date: 05/05/2023
Certification Date: 05/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

COLORADO SPRINGS ORTHOPAEDIC GROUP, DBA AUDUBON ORTHOTI 4110 BRIARGATE PARKWAY SUITE 300
COLORADO SPRINGS CO
80920-7837
US

IV. Provider business mailing address

4110 BRIARGATE PARKWAY SUITE #300
COLORADO SPRINGS CO
80920-7837
US

V. Phone/Fax

Practice location:
  • Phone: 719-632-7669
  • Fax: 719-632-0088
Mailing address:
  • Phone: 719-867-7380
  • Fax: 719-867-7311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: