Provider Demographics
NPI:1144287269
Name:ROCKY MOUNTAIN REHABILITAION MEDICINE, PC
Entity type:Organization
Organization Name:ROCKY MOUNTAIN REHABILITAION MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:YECHIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-333-4559
Mailing Address - Street 1:4500 E 9TH AVE
Mailing Address - Street 2:#150
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3900
Mailing Address - Country:US
Mailing Address - Phone:303-333-4559
Mailing Address - Fax:303-333-0057
Practice Address - Street 1:4500 E 9TH AVE
Practice Address - Street 2:#150
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3900
Practice Address - Country:US
Practice Address - Phone:303-333-4559
Practice Address - Fax:303-333-0057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04017091Medicaid
COK8008Medicare ID - Type UnspecifiedGROUP MEDICARE