Provider Demographics
NPI:1609806314
Name:ROCKY MOUNTAIN ASSOCIATES IN ORTHOPEDIC MEDICINE, PC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN ASSOCIATES IN ORTHOPEDIC MEDICINE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-669-8881
Mailing Address - Street 1:4795 LARIMER PARKWAY
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:CO
Mailing Address - Zip Code:80534-9021
Mailing Address - Country:US
Mailing Address - Phone:970-669-8881
Mailing Address - Fax:970-669-4200
Practice Address - Street 1:4795 LARIMER PARKWAY
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-9021
Practice Address - Country:US
Practice Address - Phone:970-669-8881
Practice Address - Fax:970-669-4200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04005237Medicaid
CS2495OtherRR MEDICARE
CS2495OtherRR MEDICARE