Provider Demographics
NPI:1154632511
Name:SOUTH ROCKY MEDICAL
Entity Type:Organization
Organization Name:SOUTH ROCKY MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:TERRY
Authorized Official - Last Name:DORER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-228-2263
Mailing Address - Street 1:9221 W CHATFIELD PL
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80128-9281
Mailing Address - Country:US
Mailing Address - Phone:866-228-2263
Mailing Address - Fax:720-379-7308
Practice Address - Street 1:9221 W CHATFIELD PL
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80128-9281
Practice Address - Country:US
Practice Address - Phone:866-228-2263
Practice Address - Fax:720-379-7308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-30
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4283223332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies