Healthcare Provider Details

I. General information

NPI: 1962851600
Provider Name (Legal Business Name): ROCKY MOUNTAIN BRAIN & SPINE EMERGENCY SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2016
Last Update Date: 06/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 W COUNTY LINE RD SUITE 230
HIGHLANDS RANCH CO
80129-2318
US

IV. Provider business mailing address

206 W COUNTY LINE RD SUITE 230
HIGHLANDS RANCH CO
80129-2318
US

V. Phone/Fax

Practice location:
  • Phone: 303-471-4690
  • Fax: 303-471-4697
Mailing address:
  • Phone: 303-471-4690
  • Fax: 303-471-4697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberDR.0049595
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberDR.0049595
License Number StateCO

VIII. Authorized Official

Name: ADAM P SMITH
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 303-471-4690