1710966460 NPI number — ROCKY MOUNTAIN TOX, LLC

Table of content: (NPI 1710966460)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710966460 NPI number — ROCKY MOUNTAIN TOX, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCKY MOUNTAIN TOX, LLC
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:
CORDANT HEALTH SOLUTIONS
Provider Other Organization Name Type Code:
3
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:
1710966460
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/13/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12015 E 46TH AVE
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80239-3107
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-895-8090
Provider Business Mailing Address Fax Number:
303-371-0345

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 CHAMBERS ROAD
Provider Second Line Business Practice Location Address:
SUITE J
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80011-4666
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-749-0443
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FREEMAN
Authorized Official First Name:
SYLVIA
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
MGR OF CREDENTIALING/ENROLLMENT
Authorized Official Telephone Number:
508-304-7602

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 73051845 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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