Healthcare Provider Details

I. General information

NPI: 1194325811
Provider Name (Legal Business Name): ROCKY MOUNTAIN VEIN INSTITUTE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2020
Last Update Date: 10/30/2020
Certification Date: 10/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 S UNION BLVD STE 200
COLORADO SPRINGS CO
80910-3117
US

IV. Provider business mailing address

PO BOX 7702
LOVELAND CO
80537-0702
US

V. Phone/Fax

Practice location:
  • Phone: 719-372-5555
  • Fax: 719-545-1829
Mailing address:
  • Phone: 706-632-7429
  • Fax: 970-342-2093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: GORDON F GIBBS
Title or Position: OWNER/AUTHORIZED REP
Credential: MD
Phone: 719-543-8346