Provider Demographics
NPI:1689012023
Name:ROCKY MOUNTAIN MEDICAL EXAMS, LLC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN MEDICAL EXAMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JERRIANN
Authorized Official - Middle Name:
Authorized Official - Last Name:HANCE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:719-358-6462
Mailing Address - Street 1:3510 GALLEY RD STE 104
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-4353
Mailing Address - Country:US
Mailing Address - Phone:719-358-6462
Mailing Address - Fax:719-597-9391
Practice Address - Street 1:3510 GALLEY RD STE 104
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-4353
Practice Address - Country:US
Practice Address - Phone:719-358-6462
Practice Address - Fax:719-597-9391
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO99681363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty