Provider Demographics
NPI:1245473586
Name:ROCKY MOUNTAIN COSMETIC & RECONSTRUCTIVE SURGERY ASSOC, P.C.
Entity type:Organization
Organization Name:ROCKY MOUNTAIN COSMETIC & RECONSTRUCTIVE SURGERY ASSOC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VIRGINIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:LILJESTRAND
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:303-985-3303
Mailing Address - Street 1:3280 WADSWORTH BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-4628
Mailing Address - Country:US
Mailing Address - Phone:303-985-3303
Mailing Address - Fax:303-232-3304
Practice Address - Street 1:3280 WADSWORTH BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4628
Practice Address - Country:US
Practice Address - Phone:303-985-3303
Practice Address - Fax:303-232-3304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-16
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty