Healthcare Provider Details

I. General information

NPI: 1972440535
Provider Name (Legal Business Name): INTERMOUNTAIN MEDICAL GROUP DENVER, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 EXEMPLA CIR STE 360
LAFAYETTE CO
80026-3395
US

IV. Provider business mailing address

500 ELDORADO BLVD STE 4300
BROOMFIELD CO
80021-3564
US

V. Phone/Fax

Practice location:
  • Phone: 303-272-0500
  • Fax: 303-389-6430
Mailing address:
  • Phone: 303-272-0566
  • Fax: 303-272-0390

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: SEAN FADDEN
Title or Position: VP FINANCE
Credential:
Phone: 303-425-2410