MEDICARE: ROCKY MOUNTAIN AUTISM CENTER, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	00824284	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184897175
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKY MOUNTAIN AUTISM CENTER, INC

Provider Business Mailing Address
First Line	:	8600 PARK MEADOWS DRIVE
Second Line	:	SUITE 800
City	:	LONE TREE
State	:	CO
Zip	:	80124-2757
Country	:	US
Telephone Number	:	303-985-1133
Fax Number	:

Provider Business Practice Location Address
First Line	:	8600 PARK MEADOWS DRIVE
Second Line	:	SUITE 800
City	:	LONE TREE
State	:	CO
Zip	:	80124-2757
Country	:	US
Telephone Number	:	303-985-1133
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	DR. PATRICK J RYDELL
Credential	:
Telephone Number	:	303-985-1133

Provider Enumeration Date	:	04/10/2008
Last Update Date	:	03/28/2017

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