Healthcare Provider Details

I. General information

NPI: 1023117850
Provider Name (Legal Business Name): ROCKY MOUNTAIN TRAUMA SERVICES PROFF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13918 E MISSISSIPPI AVE SUITE 473
AURORA CO
80012
US

IV. Provider business mailing address

13918 E MISSISSIPPI AVE #473
AURORA CO
80012
US

V. Phone/Fax

Practice location:
  • Phone: 303-671-2116
  • Fax: 303-369-7776
Mailing address:
  • Phone: 303-912-9915
  • Fax: 720-748-6900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. TROY STOCKMAN
Title or Position: CEO
Credential: CEO
Phone: 303-671-2116