Healthcare Provider Details

I. General information

NPI: 1720388879
Provider Name (Legal Business Name): MOUNTAIN CARDIOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2010
Last Update Date: 12/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2520 GRAND AVE STE 209
GLENWOOD SPRINGS CO
81601-4195
US

IV. Provider business mailing address

2520 GRAND AVE STE 209
GLENWOOD SPRINGS CO
81601-4195
US

V. Phone/Fax

Practice location:
  • Phone: 970-947-0600
  • Fax: 970-947-0601
Mailing address:
  • Phone: 970-947-0600
  • Fax: 970-947-0601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. REBECCA LAIRD
Title or Position: OWNER
Credential: MD
Phone: 970-947-0600