Provider Demographics
NPI:1932284122
Name:ROCKY MOUNTAIN ORTHOPEDICS INC
Entity Type:Organization
Organization Name:ROCKY MOUNTAIN ORTHOPEDICS INC
Other - Org Name:ROCKY MOUNTAIN SPINE INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LYNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-984-8881
Mailing Address - Street 1:435 SAINT MICHAELS DR STE A202
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-7644
Mailing Address - Country:US
Mailing Address - Phone:505-984-8881
Mailing Address - Fax:505-984-1551
Practice Address - Street 1:435 SAINT MICHAELS DR STE A202
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-7644
Practice Address - Country:US
Practice Address - Phone:505-984-8881
Practice Address - Fax:505-984-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2251X0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2251X0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistOrthopedicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00NA54OtherBLUE CROSS
NMQ7703Medicaid