Healthcare Provider Details

I. General information

NPI: 1699070193
Provider Name (Legal Business Name): ROCKY MOUNTAIN ORTHOPEDIC SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2011
Last Update Date: 01/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5285 MCWHINNEY BLVD STE 140
LOVELAND CO
80538-8707
US

IV. Provider business mailing address

800 E 20TH ST STE 300
CHEYENNE WY
82001-3882
US

V. Phone/Fax

Practice location:
  • Phone: 888-876-2663
  • Fax:
Mailing address:
  • Phone: 307-632-6637
  • Fax: 307-632-3382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number41285
License Number StateCO

VIII. Authorized Official

Name: W. CARLTON RECKLING
Title or Position: OWNER
Credential: M.D.
Phone: 307-632-6637