Provider Demographics
NPI:1902003676
Name:COLORADO NEUROSCIENCE CENTER OF THE ROCKIES, PLLC
Entity Type:Organization
Organization Name:COLORADO NEUROSCIENCE CENTER OF THE ROCKIES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:HIMES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:970-297-8120
Mailing Address - Street 1:1635 FOXTRAIL DR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9086
Mailing Address - Country:US
Mailing Address - Phone:970-297-8120
Mailing Address - Fax:970-776-3294
Practice Address - Street 1:1635 FOXTRAIL DR
Practice Address - Street 2:SUITE 215
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-9086
Practice Address - Country:US
Practice Address - Phone:970-297-8120
Practice Address - Fax:970-776-3294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO416312084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
B90893Medicare UPIN