Provider Demographics
NPI:1932766706
Name:ASPEN MOUNTAIN PHYSICIAN PRACTICE MANAGEMENT LLC
Entity Type:Organization
Organization Name:ASPEN MOUNTAIN PHYSICIAN PRACTICE MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:MISS
Authorized Official - First Name:TESSA
Authorized Official - Middle Name:BLAIR
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:307-352-8903
Mailing Address - Street 1:4401 COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82901-3507
Mailing Address - Country:US
Mailing Address - Phone:307-352-8903
Mailing Address - Fax:307-352-8901
Practice Address - Street 1:4401 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-3507
Practice Address - Country:US
Practice Address - Phone:307-352-8903
Practice Address - Fax:307-352-8901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-28
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty