Provider Demographics
NPI:1548412877
Name:NMC, LLC
Entity Type:Organization
Organization Name:NMC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GHISELLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-991-8133
Mailing Address - Street 1:1685 S COLORADO BLVD
Mailing Address - Street 2:SUITE 318
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80222-4000
Mailing Address - Country:US
Mailing Address - Phone:303-991-8133
Mailing Address - Fax:
Practice Address - Street 1:1685 S COLORADO BLVD
Practice Address - Street 2:SUITE 318
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4000
Practice Address - Country:US
Practice Address - Phone:303-991-8133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO414922084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F40650Medicare UPIN