Provider Demographics
NPI:1346297421
Name:ROCKY MOUNTAIN GAMMA KNIFE CENTER, LLC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN GAMMA KNIFE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOCHEVAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-366-0099
Mailing Address - Street 1:1635 AURORA COURT, MAIL STOP F752
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-2541
Mailing Address - Country:US
Mailing Address - Phone:303-366-0099
Mailing Address - Fax:303-366-1415
Practice Address - Street 1:1635 AURORA CT
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2541
Practice Address - Country:US
Practice Address - Phone:303-366-0099
Practice Address - Fax:303-366-1415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2021-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04011318Medicaid
COCR2608Medicare ID - Type UnspecifiedM GROUP PROVIDER NUMBER