Provider Demographics
NPI:1275281560
Name:ROCKY MOUNTAIN LABS LLC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN LABS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-552-0657
Mailing Address - Street 1:195 INVERNESS DR W STE 120
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80112-5212
Mailing Address - Country:US
Mailing Address - Phone:303-552-0657
Mailing Address - Fax:303-242-8474
Practice Address - Street 1:195 INVERNESS DR W STE 120
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80112-5212
Practice Address - Country:US
Practice Address - Phone:303-552-0657
Practice Address - Fax:303-242-8474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory