Healthcare Provider Details

I. General information

NPI: 1578289476
Provider Name (Legal Business Name): ROCKY MOUNTAIN CLINICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2022
Last Update Date: 03/14/2023
Certification Date: 03/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17301 W COLFAX AVE STE 275
GOLDEN CO
80401-4886
US

IV. Provider business mailing address

1120 E ELIZABETH ST STE G2
FORT COLLINS CO
80524-4044
US

V. Phone/Fax

Practice location:
  • Phone: 303-681-1894
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: SABRINA GIBSON
Title or Position: CFO
Credential:
Phone: 970-493-9193