Colorado Spine Institute Professional LLC
Organization Active NPI Orthopaedic Surgery of the Spine Physician · Johnstown, CO
NPI 1801208236 · NPPES record last updated Jun 29, 2023
Key facts
- NPI
- 1801208236
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Orthopaedic Surgery of the Spine Physician 207XS0117X
- License
- 30264 (CO)
- Legal business name
- COLORADO SPINE INSTITUTE PROFESSIONAL LLC
- Practice address
- 4795 Larimer Pkwy
Johnstown, CO 80534-9021 - Phone
- (970) 342-2220
- Fax
- (970) 342-2221
- NPI assigned
- May 20, 2014
- Organization subpart
- No
Authorized official
- Name
- Edward Jeffrey Donner, MD
- Title
- Owner
- Phone
- (970) 342-2220
Subparts reporting this organization as parent 1
Practitioners 2
-
Christopher J Kottenstette, PA-C, CPE
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150429000321 | CO | Part B Supplier - Clinic/Group Practice | 5395064182 |
Receives reassigned benefits from 2 practitioners Practice locations: Johnstown, CO |
National Provider Directory
Locations
4795 Larimer Pkwy
Ste 1
Johnstown, CO 80534
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery of the Spine Physician |
207XS0117X | 30264 | CO | Yes |
Addresses
Primary practice location
4795 Larimer Pkwy
Johnstown, CO 80534-9021
Mailing address
4795 Larimer Pkwy
Johnstown, CO 80534-9021
Phone (970) 342-2220
Other providers in Johnstown, CO
- Colorado Permanente Medical Group, P.C.
- Colorado Physiatry, PC
- Colorado Physical Therapy Specialists PLLC
- Colorado Rehabilitation Associates LLC
- Colorado Spine Institute Professional LLC
- Concord Altitude Operating Co LLC
- Concord Altitude Operating Co LLC
- Connected Chiropractic, LLC
- Ashley Covington
- Kerri Lynn Craddock
All providers in Johnstown, CO · Orthopaedic Surgery of the Spine Physician in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 29, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.