MEDICARE: ROCKY MOUNTAIN PLANNED PARENTHOOD, 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	207V00000X	Obstetrics & Gynecology Physician
2	261QA0005X	Ambulatory Family Planning Facility

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

General Provider Information

NPI Number	:	1467098897
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROCKY MOUNTAIN PLANNED PARENTHOOD, INC.

Provider Business Mailing Address
First Line	:	719 SAN MATEO BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87108-1434
Country	:	US
Telephone Number	:	505-485-0464
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 W NORTH ST
Second Line	:
City	:	CORTEZ
State	:	CO
Zip	:	81321-3117
Country	:	US
Telephone Number	:	970-565-7011
Fax Number	:	970-565-3277

Authorized Official
Title or Position	:	CREDENTIALING
Name	:	MARISSA HERRERA
Credential	:
Telephone Number	:	505-944-2021

Provider Enumeration Date	:	11/20/2019
Last Update Date	:	06/12/2023

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Directions to “ROCKY MOUNTAIN PLANNED PARENTHOOD, INC. ” Practice Location

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