Provider Demographics
NPI:1144563511
Name:ROCKY MOUNTAIN PEDIATRIC ENDOCRINOLOGY, PC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN PEDIATRIC ENDOCRINOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARISTIDES
Authorized Official - Middle Name:K
Authorized Official - Last Name:MANIATIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-420-3636
Mailing Address - Street 1:7336 S YOSEMITE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80112-2340
Mailing Address - Country:US
Mailing Address - Phone:720-420-3636
Mailing Address - Fax:720-420-3637
Practice Address - Street 1:7336 S YOSEMITE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-2340
Practice Address - Country:US
Practice Address - Phone:720-420-3636
Practice Address - Fax:720-420-3637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2013-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO401682080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO54486840Medicaid