Provider Demographics
NPI:1144279050
Name:EMERALD ORTHOPAEDICS, PC
Entity type:Organization
Organization Name:EMERALD ORTHOPAEDICS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BESS
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRACKETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-330-5400
Mailing Address - Street 1:PO BOX 336694
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80633-0612
Mailing Address - Country:US
Mailing Address - Phone:970-330-5400
Mailing Address - Fax:970-352-3118
Practice Address - Street 1:7251 W 20TH ST
Practice Address - Street 2:BLDG N
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4625
Practice Address - Country:US
Practice Address - Phone:970-330-5400
Practice Address - Fax:970-352-3118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO38270207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
008625OtherTRICARE
CO97232866Medicaid
COEM654284OtherBCBS
4595660001Medicare NSC
COC449358Medicare PIN
COEM654284OtherBCBS