=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083852123
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FRONT RANGE PLASTIC & RECONSTRUCTIVE SURGERY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2009
-----------------------------------------------------
Last Update Date | 12/14/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2500 ROCKY MOUNTAIN AVE STE 130
-----------------------------------------------------
City | LOVELAND
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80538-9004
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-872-8250
-----------------------------------------------------
Fax | 303-558-4152
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1175 58TH AVE STE 202
-----------------------------------------------------
City | GREELEY
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80634-4808
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 970-495-0300
-----------------------------------------------------
Fax | 970-224-9624
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. WARREN SCHUTTE
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 303-872-8250
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number | 47989
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------