Healthcare Provider Details

I. General information

NPI: 1578236360
Provider Name (Legal Business Name): PANORAMA ORTHOPEDICS AND SPINE CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2021
Last Update Date: 03/16/2022
Certification Date: 03/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 EAST HALE PKWY STE 330
DENVER CO
80220-4045
US

IV. Provider business mailing address

660 GOLDEN RIDGE RD STE 250
GOLDEN CO
80401-9541
US

V. Phone/Fax

Practice location:
  • Phone: 720-441-4021
  • Fax: 720-360-1195
Mailing address:
  • Phone: 303-233-1223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARK J CONKLIN
Title or Position: PRESIDENT
Credential:
Phone: 303-274-7321