Provider Demographics
NPI:1710206792
Name:ROYAL GORGE EMERGENCY MEDICINE SPECIALISTS, PLLC
Entity Type:Organization
Organization Name:ROYAL GORGE EMERGENCY MEDICINE SPECIALISTS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/CEO
Authorized Official - Prefix:
Authorized Official - First Name:HALLET
Authorized Official - Middle Name:N
Authorized Official - Last Name:WATZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-759-0854
Mailing Address - Street 1:1241 W MINERAL AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80120-5685
Mailing Address - Country:US
Mailing Address - Phone:303-759-0854
Mailing Address - Fax:303-759-0864
Practice Address - Street 1:1338 PHAY AVE
Practice Address - Street 2:ST. THOMAS MOORE
Practice Address - City:CANON CITY
Practice Address - State:CO
Practice Address - Zip Code:81212-2302
Practice Address - Country:US
Practice Address - Phone:303-759-0854
Practice Address - Fax:303-759-0864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-31
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty