Provider Demographics
NPI:1417279597
Name:ROARING FORK NEUROLOGY, P.C.
Entity Type:Organization
Organization Name:ROARING FORK NEUROLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:BIBLE
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-927-1141
Mailing Address - Street 1:350 MARKET ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-7410
Mailing Address - Country:US
Mailing Address - Phone:970-379-0452
Mailing Address - Fax:970-422-7123
Practice Address - Street 1:350 MARKET ST UNIT 1
Practice Address - Street 2:
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-7410
Practice Address - Country:US
Practice Address - Phone:970-927-1141
Practice Address - Fax:970-422-7123
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO488122084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO48812OtherCO MED LIC
CO1285780874OtherINDIVIDUAL NPI
CO1285780874OtherINDIVIDUAL NPI