Healthcare Provider Details

I. General information

NPI: 1619982089
Provider Name (Legal Business Name): ROCKY MOUNTAIN MEDICAL GROUP, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 W HAMPDEN AVENUE SUITE 200
ENGLEWOOD CO
80110-8129
US

IV. Provider business mailing address

730 W HAMPDEN AVENUE SUITE 200
ENGLEWOOD CO
80110-8129
US

V. Phone/Fax

Practice location:
  • Phone: 303-762-0900
  • Fax: 303-762-9072
Mailing address:
  • Phone: 303-762-0900
  • Fax: 303-762-9072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License Number
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NATHAN JENSEN
Title or Position: VP OF FINANCE
Credential:
Phone: 303-341-4730