Healthcare Provider Details

I. General information

NPI: 1760466601
Provider Name (Legal Business Name): SPORTS & ORTHOPAEDIC ASSOCIATES OF THE REDLANDS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 07/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2497 POWER RD UNIT 10
GRAND JUNCTION CO
81507-3085
US

IV. Provider business mailing address

2497 POWER RD UNIT 10
GRAND JUNCTION CO
81507-3085
US

V. Phone/Fax

Practice location:
  • Phone: 970-263-4079
  • Fax:
Mailing address:
  • Phone: 970-263-4079
  • Fax: 970-241-2595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. BRITT MATTHEW SMITH
Title or Position: OWNER
Credential: MSP OCS FAAOPT
Phone: 970-263-4079