Provider Demographics
NPI:1477554160
Name:ROCKY MOUNTAIN SPINE CLINIC PC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN SPINE CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-225-8120
Mailing Address - Street 1:10103 RIDGEGATE PKWY
Mailing Address - Street 2:306
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5520
Mailing Address - Country:US
Mailing Address - Phone:303-225-8120
Mailing Address - Fax:303-225-8130
Practice Address - Street 1:10103 RIDGEGATE PKWY
Practice Address - Street 2:306
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5520
Practice Address - Country:US
Practice Address - Phone:303-225-8120
Practice Address - Fax:303-225-8130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04020103Medicaid
CO49462OtherBLUE CROSS
CO49462OtherBLUE CROSS