MEDICARE: INTERMOUNTAIN MEDICAL GROUP DENVER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207VM0101X	Maternal & Fetal Medicine Physician
2	208G00000X	Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
3	207T00000X	Neurological Surgery Physician
4	207R00000X	Internal Medicine Physician
5	207V00000X	Obstetrics & Gynecology Physician
6	207X00000X	Orthopaedic Surgery Physician
7	207P00000X	Emergency Medicine Physician
8	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician
9	208100000X	Physical Medicine & Rehabilitation Physician
10	208200000X	Plastic Surgery Physician
11	261QR0206X	Mammography Clinic/Center
12	207RE0101X	Endocrinology, Diabetes & Metabolism Physician
13	207RC0000X	Cardiovascular Disease Physician
14	207RH0003X	Hematology & Oncology Physician
15	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1083021083
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERMOUNTAIN MEDICAL GROUP DENVER, LLC

Provider Business Mailing Address
First Line	:	500 ELDORADO BLVD STE 4300
Second Line	:
City	:	BROOMFIELD
State	:	CO
Zip	:	80021-3564
Country	:	US
Telephone Number	:	855-851-4127
Fax Number	:	303-272-0390

Provider Business Practice Location Address
First Line	:	1960 N OGDEN ST STE 110
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-3667
Country	:	US
Telephone Number	:	303-318-2460
Fax Number	:	303-318-2489

Authorized Official
Title or Position	:	VP FINANCE - MGPS OPERATIONS
Name	:	JON MCDANIEL
Credential	:
Telephone Number	:	303-272-0231

Provider Enumeration Date	:	07/22/2014
Last Update Date	:	06/10/2026

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