Provider Demographics
NPI: | 1376785089 |
---|---|
Name: | SPECIAL DISTRICT, HEART OF THE ROCKIES PHYSICIAN BILLING |
Entity Type: | Organization |
Organization Name: | SPECIAL DISTRICT, HEART OF THE ROCKIES PHYSICIAN BILLING |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | DIRECTOR OF PROVIDER RELATIONS |
Authorized Official - Prefix: | |
Authorized Official - First Name: | JULIE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | DESAIRE |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 970-495-0333 |
Mailing Address - Street 1: | 1000 RUSH DR |
Mailing Address - Street 2: | |
Mailing Address - City: | SALIDA |
Mailing Address - State: | CO |
Mailing Address - Zip Code: | 81201 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 719-207-8754 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1175 58TH AVE |
Practice Address - Street 2: | STE 202 |
Practice Address - City: | GREELEY |
Practice Address - State: | CO |
Practice Address - Zip Code: | 80634-4807 |
Practice Address - Country: | US |
Practice Address - Phone: | 970-495-0300 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2009-03-26 |
Last Update Date: | 2009-03-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2085R0202X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | Group - Single Specialty |