MEDICARE: THE ORCHARD CLINIC, PLLC

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	207XS0117X	Orthopaedic Surgery of the Spine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1790028041	OTHER	CO	PROVIDER NPI DR. YORK
2	1861106965	OTHER	CO	PROVIDER NPI: JESSICA DUSEBOUT
3	1922578970	OTHER	CO	PROVIDER NPI - EMILY MITCHELL

General Provider Information

NPI Number	:	1417794991
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE ORCHARD CLINIC, PLLC

Provider Business Mailing Address
First Line	:	5958 S HOLLY ST
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-4221
Country	:	US
Telephone Number	:	303-214-1055
Fax Number	:	303-214-1055

Provider Business Practice Location Address
First Line	:	5958 S HOLLY ST
Second Line	:
City	:	GREENWOOD VILLAGE
State	:	CO
Zip	:	80111-4221
Country	:	US
Telephone Number	:	303-214-1055
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PHILIP JUSTIN YORK
Credential	:	MD
Telephone Number	:	720-299-6162

Provider Enumeration Date	:	07/11/2024
Last Update Date	:	07/11/2024

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Directions to “THE ORCHARD CLINIC, PLLC ” Practice Location

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