Healthcare Provider Details

I. General information

NPI: 1336184548
Provider Name (Legal Business Name): ORTHOPEDIC PAIN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 S SHIELDS ST BLDG L
FORT COLLINS CO
80526-1827
US

IV. Provider business mailing address

2001 S SHIELDS ST BLDG L
FORT COLLINS CO
80526-1827
US

V. Phone/Fax

Practice location:
  • Phone: 970-669-8881
  • Fax: 970-669-4200
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number17195
License Number StateCO

VIII. Authorized Official

Name: HEATHER WESTLUND
Title or Position: PRACTICE MGR
Credential:
Phone: 970-669-8881