Provider Demographics
NPI:1790703239
Name:MOUNTAIN RHEUMATOLOGY LLC
Entity Type:Organization
Organization Name:MOUNTAIN RHEUMATOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:KORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-861-2190
Mailing Address - Street 1:4500 E 9TH AVE
Mailing Address - Street 2:NO 500 S
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3900
Mailing Address - Country:US
Mailing Address - Phone:303-861-2190
Mailing Address - Fax:303-355-4435
Practice Address - Street 1:4500 E 9TH AVE
Practice Address - Street 2:NO 500 S
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-3900
Practice Address - Country:US
Practice Address - Phone:303-861-2190
Practice Address - Fax:303-355-4435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-17
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200365030BMedicaid
CO84253347Medicaid
KS200365030AMedicaid