Provider Demographics
NPI:1538280466
Name:NEUROLOGY OF THE ROCKIES, LLC
Entity Type:Organization
Organization Name:NEUROLOGY OF THE ROCKIES, LLC
Other - Org Name:NEUROLOGY OF THE ROCKIES, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-840-5051
Mailing Address - Street 1:PO BOX 630920
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80163
Mailing Address - Country:US
Mailing Address - Phone:303-840-5051
Mailing Address - Fax:303-791-4685
Practice Address - Street 1:9235 CROWN CREST BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8880
Practice Address - Country:US
Practice Address - Phone:303-840-5051
Practice Address - Fax:303-791-4685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO435392084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO70553076Medicaid
CO70553076Medicaid
CO803524Medicare PIN