Provider Demographics
NPI:1194031575
Name:ROCKY MOUNTAIN BRAIN INJURY SERVICES, LLC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN BRAIN INJURY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:MADIGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-623-1148
Mailing Address - Street 1:2812 E BIJOU ST
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-6339
Mailing Address - Country:US
Mailing Address - Phone:719-457-0660
Mailing Address - Fax:719-314-0149
Practice Address - Street 1:1420 E FOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3502
Practice Address - Country:US
Practice Address - Phone:719-457-0660
Practice Address - Fax:719-314-0149
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCKY MOUNTAIN HEALTH CARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-24
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center