Provider Demographics
NPI:1770767386
Name:ROCKY MOUNTAIN NEUROLOGY PC
Entity type:Organization
Organization Name:ROCKY MOUNTAIN NEUROLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-790-8899
Mailing Address - Street 1:5975 S QUEBEC ST STE 150
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80111-4554
Mailing Address - Country:US
Mailing Address - Phone:303-790-8899
Mailing Address - Fax:303-790-2810
Practice Address - Street 1:5975 S QUEBEC ST STE 150
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80111-4554
Practice Address - Country:US
Practice Address - Phone:303-790-8899
Practice Address - Fax:303-790-2810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-19
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO379762084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO77230761Medicaid
CO77230761Medicaid
COC519648Medicare PIN