Healthcare Provider Details

I. General information

NPI: 1275281560
Provider Name (Legal Business Name): ROCKY MOUNTAIN LABS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 INVERNESS DR W STE 120
ENGLEWOOD CO
80112-5212
US

IV. Provider business mailing address

195 INVERNESS DR W STE 120
ENGLEWOOD CO
80112-5212
US

V. Phone/Fax

Practice location:
  • Phone: 303-552-0657
  • Fax: 303-242-8474
Mailing address:
  • Phone: 303-552-0657
  • Fax: 303-242-8474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: JASON HICKS
Title or Position: CEO
Credential: MD
Phone: 303-552-0657