Basic Information
| Provider Information | |||||||||
| NPI: | 1255728861 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COLORADO ORTHOPAEDICS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10103 RIDGEGATE PKWY STE 112 | ||||||||
| Address2: | |||||||||
| City: | LONE TREE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801245524 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036628250 | ||||||||
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| Practice Location | |||||||||
| Address1: | 325 S PARKSIDE DR | ||||||||
| Address2: | |||||||||
| City: | COLORADO SPRINGS | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809103134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3036628250 | ||||||||
| FaxNumber: | 3036628249 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2015 | ||||||||
| LastUpdateDate: | 10/19/2021 | ||||||||
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| AuthorizedOfficialLastName: | XENOS | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3036628250 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 10/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.