MEDICARE: DR. SAMUEL COOPER PHINNEY MD

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	208600000X	Surgery Physician	1164564837	CO
2	208600000X	Surgery Physician	0101252439	VA

General Provider Information

NPI Number	:	1164564837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAMUEL COOPER PHINNEY MD

Provider Business Mailing Address
First Line	:	2695 ROCKY MOUNTAIN AVE STE 150
Second Line	:
City	:	LOVELAND
State	:	CO
Zip	:	80538-9071
Country	:	US
Telephone Number	:	970-624-2409
Fax Number	:

Provider Business Practice Location Address
First Line	:	9330 S UNIVERSITY BLVD
Second Line	:
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80126-5065
Country	:	US
Telephone Number	:	719-364-6487
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	05/16/2024

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