Provider Demographics
NPI:1245334341
Name:ROSANNE K IVERSEN MD PC
Entity type:Organization
Organization Name:ROSANNE K IVERSEN MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ROSANNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:IVERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-871-1323
Mailing Address - Street 1:501 ANGLERS DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:STEAMBOAT
Mailing Address - State:CO
Mailing Address - Zip Code:80487
Mailing Address - Country:US
Mailing Address - Phone:970-871-1323
Mailing Address - Fax:970-871-9177
Practice Address - Street 1:501 ANGLERS DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:STEAMBOAT
Practice Address - State:CO
Practice Address - Zip Code:80487
Practice Address - Country:US
Practice Address - Phone:970-871-1323
Practice Address - Fax:970-871-9177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO31132081Medicaid
F43473Medicare UPIN
COC343608Medicare ID - Type Unspecified