Healthcare Provider Details

I. General information

NPI: 1811613912
Provider Name (Legal Business Name): ROCKY MOUNTAIN VEIN INSTITUTE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 10/19/2022
Certification Date: 10/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 S ROUTT ST STE 265
LAKEWOOD CO
80228-2214
US

IV. Provider business mailing address

PO BOX 7702
LOVELAND CO
80537-0702
US

V. Phone/Fax

Practice location:
  • Phone: 719-299-3967
  • Fax:
Mailing address:
  • Phone: 970-663-2742
  • Fax: 970-667-0847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: GORDON F GIBBS
Title or Position: AUTHORIZED REPRESENTATIVE
Credential: MD
Phone: 719-543-8346