Healthcare Provider Details

I. General information

NPI: 1073219242
Provider Name (Legal Business Name): VMD PRIMARY PROVIDERS COLORADO, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2614 S COLLEGE AVE
FORT COLLINS CO
80525-2138
US

IV. Provider business mailing address

PO BOX 32517
BELFAST ME
04915-0218
US

V. Phone/Fax

Practice location:
  • Phone: 970-224-1670
  • Fax:
Mailing address:
  • Phone: 844-969-0686
  • Fax: 866-825-4869

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: REBECCA RAGER
Title or Position: SENIOR DIRECTOR REVENUE CYCLE
Credential:
Phone: 844-969-0686