Provider Demographics
NPI:1851573976
Name:NEUROLOGY CENTER OF THE ROCKIES, LLC
Entity Type:Organization
Organization Name:NEUROLOGY CENTER OF THE ROCKIES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEREDITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-667-7664
Mailing Address - Street 1:310 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-5639
Mailing Address - Country:US
Mailing Address - Phone:970-667-7664
Mailing Address - Fax:970-622-9843
Practice Address - Street 1:310 E 5TH ST
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-5639
Practice Address - Country:US
Practice Address - Phone:970-667-7664
Practice Address - Fax:970-622-9843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO309982084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO89879384Medicaid