Provider Demographics
NPI:1073890133
Name:ROCKY MOUNTAIN DIABETES SOLUTIONS
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN DIABETES SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:GABLE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP, ADM-BC, CDE
Authorized Official - Phone:719-207-6694
Mailing Address - Street 1:PO BOX 1874
Mailing Address - Street 2:
Mailing Address - City:LEADVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80461-1874
Mailing Address - Country:US
Mailing Address - Phone:719-207-6694
Mailing Address - Fax:855-291-7480
Practice Address - Street 1:109 BROOKDALE AVE.
Practice Address - Street 2:SUITE A
Practice Address - City:BUENA VISTA
Practice Address - State:CO
Practice Address - Zip Code:81211
Practice Address - Country:US
Practice Address - Phone:719-207-6694
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-03
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONP5090261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty