Provider Demographics
NPI:1710368303
Name:ROCKY MOUNTAIN HORMONE AND WEIGHT LOSS CLINIC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN HORMONE AND WEIGHT LOSS CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TANGI
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-476-3366
Mailing Address - Street 1:6950 E BELLEVIEW AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-1618
Mailing Address - Country:US
Mailing Address - Phone:720-476-3366
Mailing Address - Fax:
Practice Address - Street 1:6950 E BELLEVIEW AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-1618
Practice Address - Country:US
Practice Address - Phone:720-476-3366
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-09
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Single Specialty