Healthcare Provider Details

I. General information

NPI: 1942926860
Provider Name (Legal Business Name): ROCKY MOUNTAIN CLINICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2022
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2224 S FRASER ST UNIT 3
AURORA CO
80014-4532
US

IV. Provider business mailing address

1120 E ELIZABETH ST STE G2
FORT COLLINS CO
80524-4044
US

V. Phone/Fax

Practice location:
  • Phone: 720-484-4428
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: SABRINA GIBSON
Title or Position: CFO
Credential:
Phone: 970-493-9193