MEDICARE: NORTHERN COLORADO HAND & WRIST CENTER PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207XS0106X	Orthopaedic Hand Surgery Physician	01038212A	IN
2	207XS0106X	Orthopaedic Hand Surgery Physician	46063	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NON46063	OTHER		ANTHEM BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033303797
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN COLORADO HAND & WRIST CENTER PC

Provider Business Mailing Address
First Line	:	1175 58TH AVE
Second Line	:	STE 202
City	:	GREELEY
State	:	CO
Zip	:	80634-4807
Country	:	US
Telephone Number	:	970-495-0300
Fax Number	:	970-224-9624

Provider Business Practice Location Address
First Line	:	2121 E HARMONY RD
Second Line	:	UNIT 260
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-3402
Country	:	US
Telephone Number	:	970-221-2827
Fax Number	:	970-221-2854

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOHN H MAHON
Credential	:	MD
Telephone Number	:	970-221-2827

Provider Enumeration Date	:	09/05/2007
Last Update Date	:	01/06/2009

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