Provider Demographics
NPI:1659647592
Name:ROCKY MOUNTAIN FAMILY PRACTICE OF LEADVILLE PC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN FAMILY PRACTICE OF LEADVILLE PC
Other - Org Name:ROCKY MOUNTAIN FAMILY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZWERDLINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:719-486-0500
Mailing Address - Street 1:735 US HIGHWAY 24
Mailing Address - Street 2:
Mailing Address - City:LEADVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80461-3978
Mailing Address - Country:US
Mailing Address - Phone:719-486-0500
Mailing Address - Fax:719-486-3966
Practice Address - Street 1:735 US HIGHWAY 24
Practice Address - Street 2:
Practice Address - City:LEADVILLE
Practice Address - State:CO
Practice Address - Zip Code:80461-3978
Practice Address - Country:US
Practice Address - Phone:719-486-0500
Practice Address - Fax:719-486-3966
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO063875261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health