Provider Demographics
NPI:1194462374
Name:ROCKY MOUNTAIN GASTROENTEROLOGY ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN GASTROENTEROLOGY ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-205-1090
Mailing Address - Street 1:3333 S WADSWORTH BLVD UNIT D100
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-5117
Mailing Address - Country:US
Mailing Address - Phone:303-205-1090
Mailing Address - Fax:
Practice Address - Street 1:1001 SOUTHPARK DR
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-5641
Practice Address - Country:US
Practice Address - Phone:303-205-1090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROCKY MOUNTAIN GASTROENTEROLOGY ASSOCIATES, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty