Healthcare Provider Details

I. General information

NPI: 1437145794
Provider Name (Legal Business Name): ORTHOPAEDIC & SPINE CENTER OF THE ROCKIES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 E PROSPECT RD AMBULATORY SURGERY CENTER & CONVALESCENT CARE CENTER
FORT COLLINS CO
80525-9718
US

IV. Provider business mailing address

2500 E PROSPECT RD AMBULATORY SURGERY CENTER & CONVALESCENT CARE CENTER
FORT COLLINS CO
80525-9718
US

V. Phone/Fax

Practice location:
  • Phone: 970-493-0112
  • Fax:
Mailing address:
  • Phone: 970-493-0112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number160343
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number160343
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number160343
License Number StateCO
# 6
Primary TaxonomyN
Taxonomy Code261QR0800X
TaxonomyRecovery Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MICHAEL BERGERSON
Title or Position: CEO
Credential:
Phone: 970-419-7005