Provider Demographics
NPI:1477615284
Name:ROCKY MOUNTAIN ENDOSCOPY CENTERS, LLC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN ENDOSCOPY CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER/AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRESSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-779-6135
Mailing Address - Street 1:10001 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-2050
Mailing Address - Country:US
Mailing Address - Phone:303-205-1090
Mailing Address - Fax:303-205-1120
Practice Address - Street 1:10001 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-2050
Practice Address - Country:US
Practice Address - Phone:303-205-1090
Practice Address - Fax:303-205-1120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-15
Last Update Date:2022-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X
CO1604XC261QE0800X
CO16R178261QE0800X
CO1604F6261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO490004296OtherRAILROAD MEDICARE
CO83326243Medicaid
CO04510376Medicaid
CO52126552Medicaid
COCA61046Medicare PIN
CO04510376Medicaid
CO04510376Medicaid