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General NPI Number Information
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NPI Number | 1669861654
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Entity Type | Organization
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Legal Business Name | ROCKY MOUNTAIN SPINE & ORTHOPEDICS
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Dates
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Enumeration Date | 01/14/2015
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Last Update Date | 01/14/2015
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Provider Practice Location Address
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Address Line | 4795 LARIMER PKWY
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City | JOHNSTOWN
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State | CO
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Zip | 80534-9021
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Country | US
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Telephone | 970-624-6333
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Fax |
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Provider Business Mailing Address
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Address Line | 4795 LARIMER PKWY
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City | JOHNSTOWN
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State | CO
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Zip | 80534-9021
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Country | US
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Telephone | 970-624-6333
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KENNETH A. PETTINE
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Credential | M.D.
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Telephone | 970-624-6333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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