MEDICARE: DR. ORRIE G CLEMENS 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	208VP0000X	Pain Medicine Physician	17195	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255312625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ORRIE G CLEMENS MD

Provider Business Mailing Address
First Line	:	1113 STONEY HILL RD STE A
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80525-1373
Country	:	US
Telephone Number	:	970-221-0565
Fax Number	:	970-221-0575

Provider Business Practice Location Address
First Line	:	2001 S SHIELDS ST
Second Line	:	BLDG L
City	:	FORT COLLINS
State	:	CO
Zip	:	80526-1827
Country	:	US
Telephone Number	:	970-221-0565
Fax Number	:	970-221-0575

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

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	11/18/2015

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