Provider Demographics
NPI:1750508404
Name:ROCKY MOUNTAIN MEDICAL GROUP, P.C.
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN MEDICAL GROUP, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:BEATTY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:303-762-0900
Mailing Address - Street 1:8380 ZUNI ST STE 205
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80221-4689
Mailing Address - Country:US
Mailing Address - Phone:303-650-6201
Mailing Address - Fax:303-650-1569
Practice Address - Street 1:8380 ZUNI ST STE 205
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80221-4689
Practice Address - Country:US
Practice Address - Phone:303-650-6201
Practice Address - Fax:303-650-1569
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
202C00000X
CO284192083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered202C00000XAllopathic & Osteopathic PhysiciansIndependent Medical ExaminerGroup - Multi-Specialty
Not Answered2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COA65358Medicare UPIN