Healthcare Provider Details

I. General information

NPI: 1568395465
Provider Name (Legal Business Name): INTERMOUNTAIN MEDICAL GROUP DENVER, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2777 MILE HIGH STADIUM CIR STE 110
DENVER CO
80211-5222
US

IV. Provider business mailing address

500 ELDORADO BLVD STE 4300
BROOMFIELD CO
80021-3564
US

V. Phone/Fax

Practice location:
  • Phone: 303-403-6480
  • Fax:
Mailing address:
  • Phone: 303-272-0566
  • Fax: 303-272-0390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHRISTOPHER AWTREY
Title or Position: ASSOCIATE CHIEF MEDICAL OFFICER
Credential: MD
Phone: 303-272-0756