Provider Demographics
NPI:1588606818
Name:ROCKY MOUNTAIN NEUROPSYCHIATRIC ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN NEUROPSYCHIATRIC ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCINIAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:719-473-2346
Mailing Address - Street 1:6160 TUTT BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80923-3503
Mailing Address - Country:US
Mailing Address - Phone:719-473-2346
Mailing Address - Fax:719-577-9627
Practice Address - Street 1:6160 TUTT BLVD STE 100
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-3503
Practice Address - Country:US
Practice Address - Phone:719-473-2346
Practice Address - Fax:719-577-9627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCJ6860OtherRAIL ROAD MEDICARE
COR0633762OtherBLUE CROSS BLUE SHIELD
COR0633762OtherBLUE CROSS BLUE SHIELD