Healthcare Provider Details

I. General information

NPI: 1437801255
Provider Name (Legal Business Name): ROCKY MOUNTAIN YOUTH MEDICAL AND NURSING CONSULTANTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2022
Last Update Date: 09/01/2022
Certification Date: 09/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 LANCER DR
FORT COLLINS CO
80521-1609
US

IV. Provider business mailing address

9197 GRANT ST STE 100
THORNTON CO
80229-4331
US

V. Phone/Fax

Practice location:
  • Phone: 970-488-4950
  • Fax:
Mailing address:
  • Phone: 303-565-5262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PAUL BROWN
Title or Position: DIRECTOR OF ADMINISTRATIVE OPERATIO
Credential:
Phone: 303-450-3690