Provider Demographics
NPI:1679002356
Name:ROCKY MOUNTAIN ANAPLASTOLOGY INC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN ANAPLASTOLOGY INC
Other - Org Name:PROSTHETIC ILLUSIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:LILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-973-8482
Mailing Address - Street 1:255 UNION BLVD STE 230
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-1861
Mailing Address - Country:US
Mailing Address - Phone:303-973-8482
Mailing Address - Fax:303-973-8468
Practice Address - Street 1:3405 S YARROW ST UNIT C
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-4901
Practice Address - Country:US
Practice Address - Phone:303-973-8482
Practice Address - Fax:303-973-8468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-07
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes229N00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersAnaplastologistGroup - Multi-Specialty
No156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularistGroup - Multi-Specialty
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
No224900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMastectomy FitterGroup - Multi-Specialty
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized EquipmentGroup - Multi-Specialty
No335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08835233Medicaid