MEDICARE: PREMIER ORTHOPEDICS

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	207X00000X	Orthopaedic Surgery Physician

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
2	PRJ3008	OTHER	CO	BLUE SHIELD GROUP ID

General Provider Information

NPI Number	:	1295783876
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER ORTHOPEDICS

Provider Business Mailing Address
First Line	:	3920 N UNION BLVD
Second Line	:	STE 330
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-4916
Country	:	US
Telephone Number	:	719-570-7272
Fax Number	:	719-570-9030

Provider Business Practice Location Address
First Line	:	3920 N UNION BLVD
Second Line	:	STE 330
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80907-4916
Country	:	US
Telephone Number	:	719-570-7272
Fax Number	:	719-570-9030

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID L. WALDEN
Credential	:	M.D.
Telephone Number	:	719-570-7272

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	04/30/2008

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