Healthcare Provider Details

I. General information

NPI: 1538432679
Provider Name (Legal Business Name): ROLAND KATO MEDICAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2012
Last Update Date: 04/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 HOSPITAL LOOP
CRAIG CO
81625-8750
US

IV. Provider business mailing address

PO BOX 912
ERIE CO
80516-0912
US

V. Phone/Fax

Practice location:
  • Phone: 970-824-9411
  • Fax:
Mailing address:
  • Phone: 702-453-3799
  • Fax: 702-453-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number48370
License Number StateCO

VIII. Authorized Official

Name: LORI LABRECQUE
Title or Position: ACCTS. MGR
Credential:
Phone: 702-453-3799