Healthcare Provider Details

I. General information

NPI: 1023186509
Provider Name (Legal Business Name): ROCKY MOUNTAIN CARDIOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2505 4TH ST
BOULDER CO
80304-3902
US

IV. Provider business mailing address

2505 4TH ST
BOULDER CO
80304-3902
US

V. Phone/Fax

Practice location:
  • Phone: 303-442-2395
  • Fax: 303-442-1073
Mailing address:
  • Phone: 303-442-2395
  • Fax: 303-442-1073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier04004420
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer

VIII. Authorized Official

Name: DR. ROY W THOMPSON
Title or Position: SENIOR PARTNER
Credential: MD
Phone: 303-442-2395