Provider Demographics
NPI:1235577768
Name:MIRAMONT CENTRAL INC.
Entity Type:Organization
Organization Name:MIRAMONT CENTRAL INC.
Other - Org Name:MIRAMONT LIFESTYLE FITNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED DIETITIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:BROOKE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:FLOERKE
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:806-786-9290
Mailing Address - Street 1:2211 S COLLEGE AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-1489
Mailing Address - Country:US
Mailing Address - Phone:970-225-2233
Mailing Address - Fax:970-472-0265
Practice Address - Street 1:2211 S COLLEGE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-1489
Practice Address - Country:US
Practice Address - Phone:970-225-2233
Practice Address - Fax:970-472-0265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1040780133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Multi-Specialty