Provider Demographics
NPI:1316636202
Name:NELSON, TIMOTHY ANDREW (BOCO)
Entity type:Individual
Prefix:MR
First Name:TIMOTHY
Middle Name:ANDREW
Last Name:NELSON
Suffix:
Gender:M
Credentials:BOCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4110 BRIARGATE PARKWAY
Mailing Address - Street 2:SUITE #300
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-7837
Mailing Address - Country:US
Mailing Address - Phone:719-867-7380
Mailing Address - Fax:719-867-7311
Practice Address - Street 1:COLORADO SPRINGS ORTHOPAEDIC GROUP, DBA AUDUBON ORTHOTI
Practice Address - Street 2:4110 BRIARGATE PARKWAY SUITE 300
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-7837
Practice Address - Country:US
Practice Address - Phone:719-632-7669
Practice Address - Fax:719-632-0088
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-05
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier