Healthcare Provider Details

I. General information

NPI: 1831800374
Provider Name (Legal Business Name): STEAMBOAT ORTHOPAEDIC AND SPINE INSTITUTE MONUMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2022
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17230 JACKSON CREEK PKWY STE 260
MONUMENT CO
80132-7305
US

IV. Provider business mailing address

705 MARKETPLACE PLZ STE 200
STEAMBOAT SPRINGS CO
80487-1841
US

V. Phone/Fax

Practice location:
  • Phone: 719-301-3010
  • Fax: 970-871-1234
Mailing address:
  • Phone: 970-879-6663
  • Fax: 970-871-1234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State

VIII. Authorized Official

Name: EMMA RUSH
Title or Position: ADMINISTRATOR
Credential:
Phone: 970-439-0800