Provider Demographics
NPI:1659620201
Name:PEDORTHIC CLINIC OF THE ROCKIES, INC
Entity Type:Organization
Organization Name:PEDORTHIC CLINIC OF THE ROCKIES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMSTRONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-305-4744
Mailing Address - Street 1:4970 MONACO ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:COMMERCE CITY
Mailing Address - State:CO
Mailing Address - Zip Code:80022-4605
Mailing Address - Country:US
Mailing Address - Phone:720-305-4744
Mailing Address - Fax:720-356-1097
Practice Address - Street 1:4970 MONACO ST
Practice Address - Street 2:UNIT B
Practice Address - City:COMMERCE CITY
Practice Address - State:CO
Practice Address - Zip Code:80022-4605
Practice Address - Country:US
Practice Address - Phone:720-305-4744
Practice Address - Fax:720-356-1097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies