Provider Demographics
NPI:1669414272
Name:ROCKY MOUNTAIN GASTROENTEROLOGY ASSOCIATES, PLLC
Entity type:Organization
Organization Name:ROCKY MOUNTAIN GASTROENTEROLOGY ASSOCIATES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:P
Authorized Official - Last Name:CMIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-205-1090
Mailing Address - Street 1:3333 S WADSWORTH BLVD
Mailing Address - Street 2:STE. D-100
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-5122
Mailing Address - Country:US
Mailing Address - Phone:303-205-1090
Mailing Address - Fax:303-205-1120
Practice Address - Street 1:3333 S WADSWORTH BLVD
Practice Address - Street 2:STE. D-100
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-5122
Practice Address - Country:US
Practice Address - Phone:303-205-1090
Practice Address - Fax:303-205-1120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CN3117OtherRAILROAD MEDICARE
CO04018503Medicaid
CN3117OtherRAILROAD MEDICARE