1669414272 NPI number — ROCKY MOUNTAIN GASTROENTEROLOGY ASSOCIATES, PLLC

Table of content: (NPI 1669414272)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669414272 NPI number — ROCKY MOUNTAIN GASTROENTEROLOGY ASSOCIATES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCKY MOUNTAIN GASTROENTEROLOGY ASSOCIATES, PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669414272
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3333 S WADSWORTH BLVD
Provider Second Line Business Mailing Address:
STE. D-100
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80227-5122
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-205-1090
Provider Business Mailing Address Fax Number:
303-205-1120

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3333 S WADSWORTH BLVD
Provider Second Line Business Practice Location Address:
STE. D-100
Provider Business Practice Location Address City Name:
LAKEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80227-5122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-205-1090
Provider Business Practice Location Address Fax Number:
303-205-1120
Provider Enumeration Date:
06/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CMIL
Authorized Official First Name:
ALEXANDER
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
303-205-1090

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CN3117 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 04018503 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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