Healthcare Provider Details

I. General information

NPI: 1215054259
Provider Name (Legal Business Name): ROCKY MOUNTAIN FAMILY PHYSICIANS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 02/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 E ELIZABETH ST BLDG C
FORT COLLINS CO
80524-4052
US

IV. Provider business mailing address

1124 E ELIZABETH ST BLDG C
FORT COLLINS CO
80524-4052
US

V. Phone/Fax

Practice location:
  • Phone: 970-484-0798
  • Fax: 970-482-0679
Mailing address:
  • Phone: 970-484-0798
  • Fax: 970-482-0679

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD L MCMULLEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 970-484-0798