Healthcare Provider Details

I. General information

NPI: 1316779929
Provider Name (Legal Business Name): ALLERGY, ASTHMA, & IMMUNOLOGY OF THE ROCKIES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2024
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 BENCHMARK RD STE C103B-3
AVON CO
81620-5415
US

IV. Provider business mailing address

1810 GRAND AVE
GLENWOOD SPRINGS CO
81601-4112
US

V. Phone/Fax

Practice location:
  • Phone: 970-947-0600
  • Fax: 970-947-0601
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number
License Number State

VIII. Authorized Official

Name: SAMUEL ALTMAN
Title or Position: VP RCM
Credential:
Phone: 469-209-8355