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	License Number	License Number State
1	207T00000X	Neurological Surgery Physician
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician

General Provider Information

NPI Number	:	1649884057
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERMOUNTAIN MEDICAL GROUP DENVER, LLC

Provider Business Mailing Address
First Line	:	500 ELDORADO BLVD STE 6300
Second Line	:
City	:	BROOMFIELD
State	:	CO
Zip	:	80021-3422
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1830 N FRANKLIN ST STE 340
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-1128
Country	:	US
Telephone Number	:	303-318-3595
Fax Number	:	303-318-3597

Authorized Official
Title or Position	:	ASSOCIATE CHIEF MEDICAL OFFICER
Name	:	CHRISTOPHER AWTREY
Credential	:
Telephone Number	:	303-272-0756

Provider Enumeration Date	:	09/02/2020
Last Update Date	:	06/16/2026

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