Provider Demographics
NPI:1942237136
Name:MOUNTAIN STATES NEUROLOGY, PC
Entity Type:Organization
Organization Name:MOUNTAIN STATES NEUROLOGY, PC
Other - Org Name:COLORADO NEUROLOGY, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLAZZO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-762-6666
Mailing Address - Street 1:701 E HAMPDEN AVE SUITE #530
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80113
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 E HAMPDEN AVE SUITE #530
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80113
Practice Address - Country:US
Practice Address - Phone:303-788-4600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO4012126Medicaid
CO1053305656OtherNPI
CO1245223296OtherNPI
CO1457345753OtherNPI
CO1255324208OtherNPI
CO1346233384OtherNPI
CO1417940453OtherNPI
CO1790778744OtherNPI
CO1003800301OtherNPI
CO1457345746OtherNPI
CO1245223296OtherNPI