Healthcare Provider Details

I. General information

NPI: 1477576890
Provider Name (Legal Business Name): STEAMBOAT ORTHOPAEDIC ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 03/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 CENTRAL PARK DR #190
STEAMBOAT SPRINGS CO
80487-8816
US

IV. Provider business mailing address

940 CENTRAL PARK DR #190
STEAMBOAT SPRINGS CO
80487-8816
US

V. Phone/Fax

Practice location:
  • Phone: 970-879-4612
  • Fax: 970-879-0583
Mailing address:
  • Phone: 970-879-4612
  • Fax: 970-879-0583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateCO

VIII. Authorized Official

Name: MR. MATTHEW MOSELEY WALTON
Title or Position: ADMINISTRATOR & CFO
Credential: MBA
Phone: 970-879-4612