Healthcare Provider Details

I. General information

NPI: 1285680561
Provider Name (Legal Business Name): COLORADO COMPREHENSIVE SPINE INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3277 S LINCOLN ST
ENGLEWOOD CO
80113-2512
US

IV. Provider business mailing address

3277 S LINCOLN ST
ENGLEWOOD CO
80113
US

V. Phone/Fax

Practice location:
  • Phone: 303-762-0808
  • Fax: 303-762-9292
Mailing address:
  • Phone: 303-762-0808
  • Fax: 303-762-9292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: DENISE L FERGUSON
Title or Position: ADMINISTRATOR
Credential:
Phone: 720-274-0319