Provider Demographics
NPI:1578140976
Name:SPORTS MEDICINE OF THE ROCKIES PLLC
Entity Type:Organization
Organization Name:SPORTS MEDICINE OF THE ROCKIES PLLC
Other - Org Name:SPORTS MEDICINE OF THE ROCKIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLOSE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-534-0388
Mailing Address - Street 1:13402 W COAL MINE AVE STE 250
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-5409
Mailing Address - Country:US
Mailing Address - Phone:303-534-0388
Mailing Address - Fax:
Practice Address - Street 1:13402 W COAL MINE AVE STE 250
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-5409
Practice Address - Country:US
Practice Address - Phone:303-534-0388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-24
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PS0010XAllopathic & Osteopathic PhysiciansEmergency MedicineSports MedicineGroup - Single Specialty