Healthcare Provider Details

I. General information

NPI: 1689889966
Provider Name (Legal Business Name): ORTHOPEDIC SURGERY & SPORTS MEDICINE SPECIALIST
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 04/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9141 GRANT ST STE 10
THORNTON CO
80229-4374
US

IV. Provider business mailing address

9141 GRANT ST # 10
THORNTON CO
80229-4374
US

V. Phone/Fax

Practice location:
  • Phone: 303-450-6800
  • Fax: 303-450-7153
Mailing address:
  • Phone: 303-450-6800
  • Fax: 303-450-7153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. TERRY JOEL WINTORY
Title or Position: OWNER
Credential: DO
Phone: 303-450-6800