Healthcare Provider Details

I. General information

NPI: 1588190979
Provider Name (Legal Business Name): RICHARD LEE AMENDOLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2017
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 W MEADOW DR STE 400
VAIL CO
81657-5058
US

IV. Provider business mailing address

181 W MEADOW DR STE 400
VAIL CO
81657-5058
US

V. Phone/Fax

Practice location:
  • Phone: 970-476-1100
  • Fax:
Mailing address:
  • Phone: 970-476-1100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDR.0067797
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: