Basic Information
| Provider Information | |||||||||
| NPI: | 1659340305 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROCKY MOUNTAIN OBGYN PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4500 EAST 9TH AVENUE | ||||||||
| Address2: | BLDG II, STE 200 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802203921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033990055 | ||||||||
| FaxNumber: | 3033997764 | ||||||||
| Practice Location | |||||||||
| Address1: | 4500 EAST 9TH AVENUE | ||||||||
| Address2: | BLDG II, STE 200 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802203921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3033990055 | ||||||||
| FaxNumber: | 3033997764 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2006 | ||||||||
| LastUpdateDate: | 11/04/2009 | ||||||||
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| AuthorizedOfficialLastName: | NICHOLAS | ||||||||
| AuthorizedOfficialFirstName: | BARBARA | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3033990055 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | CO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 4021614 | 05 | CO | MEDICAID |