Healthcare Provider Details

I. General information

NPI: 1750873667
Provider Name (Legal Business Name): SUMMIT ORTHOPEDICS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2018
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

68 SCHOOL ROAD SUITE 100
FRISCO CO
80443
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 970-262-7400
  • Fax: 970-262-7401
Mailing address:
  • Phone: 303-724-7321
  • Fax: 720-497-6741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

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