Healthcare Provider Details

I. General information

NPI: 1780801787
Provider Name (Legal Business Name): ROCKY MOUNTAIN MEDICAL GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2007
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13650 E MISSISSIPPI AVE STE 120
AURORA CO
80012-3573
US

IV. Provider business mailing address

750 W HAMPDEN AVE STE 105
ENGLEWOOD CO
80110-2167
US

V. Phone/Fax

Practice location:
  • Phone: 720-748-7072
  • Fax: 720-748-7074
Mailing address:
  • Phone: 303-341-4730
  • Fax: 303-341-4708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number28419
License Number StateCO

VIII. Authorized Official

Name: NATHAN JENSEN
Title or Position: VP OF FINANCE
Credential:
Phone: 303-341-4730