=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295783876
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREMIER ORTHOPEDICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/05/2006
-----------------------------------------------------
Last Update Date | 04/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3920 N UNION BLVD STE 330
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80907-4916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-570-7272
-----------------------------------------------------
Fax | 719-570-9030
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3920 N UNION BLVD STE 330
-----------------------------------------------------
City | COLORADO SPRINGS
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80907-4916
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 719-570-7272
-----------------------------------------------------
Fax | 719-570-9030
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DAVID L. WALDEN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 719-570-7272
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------