Healthcare Provider Details

I. General information

NPI: 1710691647
Provider Name (Legal Business Name): CENTURA SUMMIT ORTHOPEDICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2023
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 SCHOOL RD STE 100
FRISCO CO
80443
US

IV. Provider business mailing address

PO BOX 650823 DEPT 42409
DALLAS TX
75265-0823
US

V. Phone/Fax

Practice location:
  • Phone: 970-262-7400
  • Fax: 970-262-7401
Mailing address:
  • Phone: 970-262-7400
  • Fax: 920-262-7401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELA J SKINNER
Title or Position: ADMINISTRATOR, OMA
Credential:
Phone: 720-667-7283