MEDICARE: PANORAMA ORTHOPEDICS AND SPINE CENTER PC

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	261QP2000X	Physical Therapy Clinic/Center

General Provider Information

NPI Number	:	1942808548
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PANORAMA ORTHOPEDICS AND SPINE CENTER PC

Provider Business Mailing Address
First Line	:	660 GOLDEN RIDGE RD STE 250
Second Line	:
City	:	GOLDEN
State	:	CO
Zip	:	80401-9541
Country	:	US
Telephone Number	:	303-274-7321
Fax Number	:

Provider Business Practice Location Address
First Line	:	2706 28TH ST
Second Line	:
City	:	BOULDER
State	:	CO
Zip	:	80301-1222
Country	:	US
Telephone Number	:	303-233-1223
Fax Number	:	303-233-8755

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARK J CONKLIN
Credential	:
Telephone Number	:	303-274-7321

Provider Enumeration Date	:	10/15/2020
Last Update Date	:	10/15/2020

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