Provider Demographics
NPI:1497212112
Name:ROCKY MOUNTAIN MEDICAL GROUP, P.C.
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN MEDICAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:JENSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-341-4730
Mailing Address - Street 1:750 W HAMPDEN AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80110-2167
Mailing Address - Country:US
Mailing Address - Phone:303-341-4730
Mailing Address - Fax:303-341-4708
Practice Address - Street 1:4800 BASELINE RD STE D106
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2643
Practice Address - Country:US
Practice Address - Phone:303-499-4800
Practice Address - Fax:303-499-4892
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-28
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Single Specialty