MEDICARE: SPORTS & ORTHOPAEDIC ASSOCIATES OF THE REDLANDS, LLC

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	261Q00000X	Clinic/Center

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CF8038	OTHER	CO	RAILROAD MEDICARE PIN

General Provider Information

NPI Number	:	1760466601
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPORTS & ORTHOPAEDIC ASSOCIATES OF THE REDLANDS, LLC

Provider Business Mailing Address
First Line	:	2497 POWER RD
Second Line	:	UNIT 10
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81507-3085
Country	:	US
Telephone Number	:	970-263-4079
Fax Number	:	970-241-2595

Provider Business Practice Location Address
First Line	:	2497 POWER RD
Second Line	:	UNIT 10
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81507-3085
Country	:	US
Telephone Number	:	970-263-4079
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. BRITT MATTHEW SMITH
Credential	:	MSP OCS FAAOPT
Telephone Number	:	970-263-4079

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	07/23/2013

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