Provider Demographics
NPI:1518564368
Name:ALLERGY, ASTHMA & IMMUNOLOGY OF THE ROCKIES, PC
Entity Type:Organization
Organization Name:ALLERGY, ASTHMA & IMMUNOLOGY OF THE ROCKIES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCDERMOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-947-0600
Mailing Address - Street 1:PO BOX #2601
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81602-2601
Mailing Address - Country:US
Mailing Address - Phone:970-947-0600
Mailing Address - Fax:970-947-0601
Practice Address - Street 1:377 SYLVAN LAKE ROAD
Practice Address - Street 2:SUITE #140
Practice Address - City:EAGLE
Practice Address - State:CO
Practice Address - Zip Code:81631
Practice Address - Country:US
Practice Address - Phone:970-947-0600
Practice Address - Fax:978-947-0601
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALLERGY, ASTHMA & IMMUNOLOGY OF THE ROCKIES, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-10-05
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO51036746Medicaid