1063614535 NPI number — ROCKY MOUNTAIN HEALTH CENTERS PEDIATRICS, PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063614535 NPI number — ROCKY MOUNTAIN HEALTH CENTERS PEDIATRICS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROCKY MOUNTAIN HEALTH CENTERS PEDIATRICS, PC
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:
1063614535
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14001 E ILIFF AVE STE 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AURORA
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80014-1425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-996-9601
Provider Business Mailing Address Fax Number:
303-369-2605

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14001 E ILIFF AVE STE 210
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80014-1425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-996-9691
Provider Business Practice Location Address Fax Number:
303-369-2605
Provider Enumeration Date:
06/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
THALER
Authorized Official First Name:
ALISON
Authorized Official Middle Name:
RENEE
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
303-996-9601

Provider Taxonomy Codes

  • Taxonomy code: 2080A0000X , with the licence number:  23399 , 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: 10338381 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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