Provider Demographics
NPI:1720388879
Name:MOUNTAIN CARDIOLOGY, PC
Entity Type:Organization
Organization Name:MOUNTAIN CARDIOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:LAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-947-0600
Mailing Address - Street 1:2520 GRAND AVE STE 209
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81601-4195
Mailing Address - Country:US
Mailing Address - Phone:970-947-0600
Mailing Address - Fax:970-947-0601
Practice Address - Street 1:2520 GRAND AVE STE 209
Practice Address - Street 2:
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-4195
Practice Address - Country:US
Practice Address - Phone:970-947-0600
Practice Address - Fax:970-947-0601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO39736814Medicaid
COCO303497Medicare PIN