Provider Demographics
NPI:1003869405
Name:NEUROLOGY CENTER OF THE ROCKIES
Entity Type:Organization
Organization Name:NEUROLOGY CENTER OF THE ROCKIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:MEREDITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-667-7664
Mailing Address - Street 1:310 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-5639
Mailing Address - Country:US
Mailing Address - Phone:970-667-7664
Mailing Address - Fax:970-622-9843
Practice Address - Street 1:310 E 5TH ST
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-5639
Practice Address - Country:US
Practice Address - Phone:970-667-7664
Practice Address - Fax:970-622-9843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO30998174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COE60447Medicare UPIN