Healthcare Provider Details

I. General information

NPI: 1679002356
Provider Name (Legal Business Name): ROCKY MOUNTAIN ANAPLASTOLOGY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2017
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 S YARROW ST UNIT C
LAKEWOOD CO
80227-4901
US

IV. Provider business mailing address

255 UNION BLVD STE 230
LAKEWOOD CO
80228-1861
US

V. Phone/Fax

Practice location:
  • Phone: 303-973-8482
  • Fax: 303-973-8468
Mailing address:
  • Phone: 303-973-8482
  • Fax: 303-973-8468

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code156FX1700X
TaxonomyOcularist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code224900000X
TaxonomyMastectomy Fitter
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code229N00000X
TaxonomyAnaplastologist
License Number
License Number State

VIII. Authorized Official

Name: BARBARA Y LILLO
Title or Position: PRESIDENT
Credential:
Phone: 303-973-8482