Provider Demographics
NPI:1871539478
Name:ADVANCED ORTHOPEDIC AND SPORTS MEDICINE SPECIALISTS, PC
Entity type:Organization
Organization Name:ADVANCED ORTHOPEDIC AND SPORTS MEDICINE SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVIS
Authorized Official - Middle Name:KENDRICK
Authorized Official - Last Name:HURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-344-9090
Mailing Address - Street 1:8101 E LOWRY BLVD
Mailing Address - Street 2:STE 230
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230
Mailing Address - Country:US
Mailing Address - Phone:303-344-9090
Mailing Address - Fax:303-344-1922
Practice Address - Street 1:8101 E LOWRY BLVD
Practice Address - Street 2:STE 230
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80230
Practice Address - Country:US
Practice Address - Phone:303-344-9090
Practice Address - Fax:303-344-1922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04005989Medicaid
COCE1836Medicare PIN
COCG2208Medicare PIN
CO04005989Medicaid