Healthcare Provider Details

I. General information

NPI: 1710966460
Provider Name (Legal Business Name): ROCKY MOUNTAIN TOX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2006
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 CHAMBERS ROAD SUITE J
AURORA CO
80011-4666
US

IV. Provider business mailing address

12015 E 46TH AVE SUITE 250
DENVER CO
80239-3107
US

V. Phone/Fax

Practice location:
  • Phone: 303-749-0443
  • Fax:
Mailing address:
  • Phone: 855-895-8090
  • Fax: 303-371-0345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateCO

VIII. Authorized Official

Name: SYLVIA LYNN FREEMAN
Title or Position: MGR OF CREDENTIALING/ENROLLMENT
Credential:
Phone: 508-304-7602