# ORTHOPAEDIC & SPINE CENTER OF THE ROCKIES PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770579385
- **Authorized official:** MR. MICHAEL BERGERSON (CHIEF EXECUTIVE OFFICER)
- **Authorized official phone:** (970) 419-7005

## Contact information

- **Practice address:** 2500 E PROSPECT RD, FORT COLLINS, CO 80525-9718
- **Practice address phone:** (970) 493-0112
- **Mailing address:** 2500 E PROSPECT RD, FORT COLLINS, CO 80525-9718
- **Mailing address phone:** (970) 493-0112

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | NULL | Yes |
| 207X00000X | Orthopaedic Surgery Physician | — | — | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | — |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | — |
| 2085R0202X | Diagnostic Radiology Physician | — | NULL | — |
| 2085R0202X | Diagnostic Radiology Physician | — | — | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | NULL | — |
| 213ES0103X | Foot & Ankle Surgery Podiatrist | — | — | — |
| 335E00000X | Prosthetic/Orthotic Supplier | — | NULL | — |

## Other

- **Enumeration date:** 09/20/2005
- **Last updated:** 12/30/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 04640082 | — | CO |
| 05 | — | 107463601 | — | WY |
| 01 | — | CS8670 | RR MEDICARE | CO |