Provider Demographics
NPI:1023117850
Name:ROCKY MOUNTAIN TRAUMA SERVICES PROFF LLC
Entity type:Organization
Organization Name:ROCKY MOUNTAIN TRAUMA SERVICES PROFF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:
Authorized Official - Last Name:STOCKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:CEO
Authorized Official - Phone:303-671-2116
Mailing Address - Street 1:13918 E MISSISSIPPI AVE
Mailing Address - Street 2:#473
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012
Mailing Address - Country:US
Mailing Address - Phone:303-912-9915
Mailing Address - Fax:720-748-6900
Practice Address - Street 1:13918 E MISSISSIPPI AVE
Practice Address - Street 2:SUITE 473
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012
Practice Address - Country:US
Practice Address - Phone:303-671-2116
Practice Address - Fax:303-369-7776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO93731759Medicaid
CO93731759Medicaid