Healthcare Provider Details

I. General information

NPI: 1063630226
Provider Name (Legal Business Name): ROARING FORK FAMILY PHYSICIANS, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 10/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1340 HIGHWAY 133
CARBONDALE CO
81623-1933
US

IV. Provider business mailing address

1340 HIGHWAY 133
CARBONDALE CO
81623-1933
US

V. Phone/Fax

Practice location:
  • Phone: 970-963-3350
  • Fax: 970-963-2958
Mailing address:
  • Phone: 970-963-3350
  • Fax: 970-963-2958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateCO

VIII. Authorized Official

Name: MR. RICHARD A HERRINGTON
Title or Position: PRESIDENT
Credential: M.D.
Phone: 970-963-3350