MEDICARE: STEAMBOAT SPINE AND SPORTS INC.

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	2081S0010X	Sports Medicine (Physical Medicine & Rehabilitation) Physician	3430	CO

General Provider Information

NPI Number	:	1760543490
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEAMBOAT SPINE AND SPORTS INC.

Provider Business Mailing Address
First Line	:	1560 PINE GROVE RD STE B
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487-8006
Country	:	US
Telephone Number	:	970-879-7031
Fax Number	:	970-879-4928

Provider Business Practice Location Address
First Line	:	1560 PINE GROVE RD STE B
Second Line	:
City	:	STEAMBOAT SPRINGS
State	:	CO
Zip	:	80487
Country	:	US
Telephone Number	:	970-879-7031
Fax Number	:	970-879-4928

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FINN BURNETT GERSTELL
Credential	:
Telephone Number	:	970-879-7031

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	02/18/2019

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